Abstract 14358: Coronary Anatomy and Comorbidities in Stress-Induced Cardiomyopathy

Abstract

BACKGROUND: Previous studies indicated patients with stress-induced cardiomyopathy (SIC) present with apical ballooning of the left ventricle during severe emotional stress. The psychosomatic mechanism explaining how emotional stress can cause myocardial dysfunction is hypothesized to be neurogenic coronary vasospasm causing ischemia despite normal coronary anatomy.

METHOD: 50 patients (35 F, 15 M) with mean age 62 ±14 years, who were admitted with SIC from 2006 to 2012 were divided into groups by presence or absence of coronary stenosis(CS) for evaluation of coronary anatomy, LV function, risk factor profile, comorbidities, and stress type. RESULTS: 24 patients with mean age of 53 ±2 years without structural CS(Group A) were younger than 26 patients with mean age of 68 ±4 years with minimal, or insignificant CS(Group B): (P:0.015), with CS of LAD (35 ±5%), LCX (45 ±19%), and RCA (50 ±10%):(P:NS). Ejection fraction of 39 ±5 vs. 36 ±4%,Troponin of 9.4 ±2 vs. 6.5 ±6 ng/dl, LDL of 101±15 vs. 78 ±8 mg/dl, HDL of 42 ±5 vs. 6.5 ±4mg/dl,TG of 154 ±100 vs.125 ±65mg/dl, and cholesterol of 184.6 ±57 vs 148.43 ±38 were not different between two groups (P:NS). CK-MB at time of admission was higher in Group B with 12 ±2 vs. 6 ±2 ng/dl in Group A (p:0.038), shown as a more frequent ECG pattern of transmural myocardial infarction in Group B in follow up studies (7 vs. 1, P: 0.04). Patients had more than one co-morbidity including diabetes, hypertension, obesity, dyslipidemia, renal and respiratory failures, and CNS issues. Symptoms mimic that of acute coronary syndrome and congestive heart failure. No patients had psychiatric issues manifesting as seeking psychiatric referral and hospitalization or chronic use of psychotropic medications, but had acute distress related to situational stress due to unforeseen events such as accidents and illnesses to family members, stroke, subdural hematoma, severe pain, or anxiety waiting for major surgery. All patients had clinical improvement with beta blocker treatment. CONCLUSION: SIC caused by situational stress may not be a benign clinical entity only with normal coronary anatomy. Ongoing coronary disease from endothelial dysfunction to minimal and advanced coronary lesions may be a precondition for disease manifestation in many patients.