Abstract 16751: Prevalence and Outcome of Cardiogenic Shock in Patients With Takotsubo Cardiomyopathy
Purpose: Tako-tsubo cardiomyopathy (TTC) is regarded a benign disease since left ventricular (LV) function returns to normal within a short period of time. However, severe complications have been described in a limited number of patients (pts).
This study evaluated the frequency and outcome of cardiogenic shock in a large TTC registry.
Methods: From 37 heart centers, 324 pts (296 f, 28 m, age 68±12) were included in the registry according to established TTC criteria. Complete data on complications were available in the last 209 registry pts.
Results: Complications developed in 108/209 pts (52%) within 2.6±2.9 days (median 1 [IQR 1-3] days) after symptom onset; 51 of these pts (24%) experienced >1 and 23 (11%) >2 complications. Most complications (77%) occurred within 3 days after symptom onset, however, 23% developed later (from day 4 to 56).
Fourteen of 209 pts (7%) experienced cardiogenic shock which developed on the day of admission in 11 pts (79%) and from day 2 to day 4 after admission in 3 pts (21%). Seven of these patients (50%) were also in pulmonary oedema. The ECG on admission showed a higher heart rate (92±24 vs. 76±17 beats per minute, p<0.001) and more Q waves in pts with cardiogenic shock (54% vs. 27%, p=0.043). Cardiac markers were significantly higher (creatine kinase 4.3±5.7 vs. 1.8±3.8 [p<0.05] and troponin 62.1±109 vs. 10.7±11.9 [p<0.001] times the upper limit of normal), and ejection fraction was lower (38±9 vs. 51±15%, p<0.005). Intraaortic balloon pumping was applied in 2/14 pts, and catecholamines were administered in 8 pts. Four of 14 TTC pts with cardiogenic shock (29%) died, 2 from multiorgan failure and 1 pt each from refractory cardiogenic shock and LV rupture. In the latter pt ST-segment elevation persisted for 3 days when myocardial perforation occurred.
Conclusion: Cardiogenic shock occurs in 7% of pts with TTC. The prevalence of cardiogenic shock is similar to findings in reperfused myocardial infarction (5-10%). However, the mortality of cardiogenic shock in TTC pts appears to be lower (29%) than reported in reperfused patients with STEMI (42-62%). This may be due to the early spontaneous reversibility of LV dysfunction in TTC.
- © 2013 by American Heart Association, Inc.