Abstract 16800: Influence of Triggering Events on the Manifestation and Clinical Course of Takotsubo Cardiomyopathy
Purpose: Takotsubo cardiomyopathy (TTC), an acute form of heart failure, is often preceded by stressful events. In a large registry we evaluated the influence of triggering events on the manifestation of TTC.
Methods: From 37 hospitals, 324 pts (296f, 28m, age 68±12) were included in the registry according to established TTC criteria. All pts were asked if a stressful event preceded TTC onset.
Results: A trigger was identified in 77%. Emotional stress was reported by 117 (36%), physical stress by 104 (31%) and a combination of both stress modalities felt to be equal by 29 pts (9%). In 74 pts (23%) no trigger was identified. The 4 groups were compared by analysis of variance.
Age was not different. Physical stress was more frequent in males (57% vs 30%, p=0.005), emotional stress or no identifiable trigger were more prevalent in women. Pts with emotional stress as compared with physical, both or no stress more frequently complained about angina (94% vs 57% vs 59% vs 64%, p<0.0001) and less frequently about dyspnea (3% vs 24% vs 34% vs 15%, p<0.0001). Emotional and physical stress were more frequent on Friday and in winter (p<0.03). Prehospital delay was longer with emotional than with physical stress (8.9±7.4 vs 6.9±7.3 hours, p<0.05).
Admission heart rate was lower in emotional than in physical stress (81±18 vs 93±26/min, p=0.007). The QTc interval was longer in emotional stress compared to pts without a trigger (513±61 vs 486±59 ms, p=0.03). Other ECG parameters, cardiac markers, ejection fraction or complications were similar in all groups.
Since pulmonary disease often is the physical trigger for TTC, a pre-medication with betamimetics was more frequently seen with physical stress (18%) or both stress forms (31%) than with emotional (2%) or no stress (0%), p<0.0001. Pts without an identifiable trigger more frequently required catecholamines (12% vs 0% vs 6% vs 5%, p=0.009) or intraaortic balloon pumping (4% vs 0%, p=0.03).
Conclusion: Pts with emotional stress triggering TTC frequently have angina, a longer prehospital delay and a lower heart rate. Due to lung disease, pts with physical or both stress forms more frequently have dyspnea and a pre-treatment with betamimetics which may play a pathophysiologic role in TTC. Pts without a trigger have a more severe clinical course.
- © 2013 by American Heart Association, Inc.