The Natural History of Takotsubo Cardiomyopathy

In the 25 years since first being described, takotsubo (stress) cardiomyopathy has gained increasing recognition as a common clinical entity.  Despite this, our understanding of the natural history of takotsubo cardiomyopathy remains limited.  The International Takotsubo Registry has been gathering data on takotsubo cases since 1998 and this publication describes their findings to date.  Among 1,750 patients with takotsubo cardiomyopathy, 90% were women, the mean age was 66.8 years, and psychiatric or neurological disorders were common (56%). Approximately one-quarter of presentations were triggered by an emotional event, slightly more than one-third by a physical event, and the remainder had no identified trigger. Rates of in-hospital cardiogenic shock and death were similar to rates of these events in a matched cohort of patients presenting with an acute coronary syndrome.  Predictors of in-hospital complications of takotsubo cardiomyopathy included a physical event triggering presentation, acute neurologic or psychiatric diseases, high troponin levels, and a low ejection fraction on admission.  In follow-up, the risk of major adverse events was 9.9% per patient-year and the risk of death was 5.6% per patient-year. In this observational analysis, treatment with an ACE I or ARB was associated with significantly improved prognosis, while no effect was observed with beta-blockade.  Rates of takotsubo recurrence were 1.8% per patient year.

Conclusions: This observational study from a large registry of patients with takosubo cardiomyopathy provides important insights on the natural history of the disease and predictors of poor outcomes.  Further research is needed to define optimal treatment strategies for this high risk patient population.

Summarized by Hussain Contractor and Steven M. Bradley

Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, Cammann VL, Sarcon A, Geyer V, Neumann CA, Seifert B, Hellermann J, Schwyzer M, Eisenhardt K, Jenewein J, Franke J, Katus HA, Burgdorf C, Schunkert H, Moeller C, Thiele H, Bauersachs J, Tschöpe C, Schultheiss HP, Laney CA, Rajan L, Michels G, Pfister R, Ukena C, Böhm M, Erbel R, Cuneo A, Kuck KH, Jacobshagen C, Hasenfuss G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Cuculi F, Banning A, Fischer TA, Vasankari T, Airaksinen KE, Fijalkowski M, Rynkiewicz A, Pawlak M, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, Erne P, Bax JJ, Ford I, Ruschitzka F, Prasad A, Lüscher TF. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. N Engl J Med. 2015 Sep 3;373(10):929-38.


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