Key result
Physical stressors in Tako-tsubo cardiomyopathy were associated with higher rates of cardiogenic shock (P=0.040) and longer in-hospital stays (P=0.001) compared to other triggers.
Why the study?
Does the type of preceding stressor pattern affect clinical features and in-hospital outcomes in patients with Tako-tsubo cardiomyopathy?
Observational (n=137)
Yes
Does the type of preceding stressor pattern affect clinical features and in-hospital outcomes in patients with Tako-tsubo cardiomyopathy?
Tako-tsubo cardiomyopathy triggered by physical stressors is associated with worse hemodynamic compromise, lower LVEF, and longer hospital stays compared to emotional or no triggers.
Trigger type may anticipate TTC presentation differences; leaves open whether it should guide risk stratification or therapy.
BACKGROUND: Tako-tsubo cardiomyopathy (TTC) is typically triggered by an acute emotional or physical stress event. The aim of this study was to investigate the impact of stressor patterns on clinical features, laboratory parameters, and electrocardiographic and echocardiographic findings in patients with TTC. HYPOTHESIS: Clinical features are different according to stressor patterns. METHODS: Of 137 patients enrolled from the TTC registry database, 14 patients had emotional triggers (E group), 96 had physical triggers (P group), and 27 had no triggers (N group). RESULTS: Most clinical presentations and in-hospital courses were similar among the groups. However, the E group had a higher prevalence of chest pain (P = 0.006) and palpitation (P = 0.006), whereas the P group had a higher prevalence of cardiogenic shock (P = 0.040), than other groups. The P group had a significantly higher heart rate (P = 0.001); higher high-sensitivity C-reactive protein (P = 0.006), creatine kinase MB fraction (P = 0.045), and N terminal-probrain natriuretic peptide (P = 0.036) levels; higher left ventricular end-diastolic pressure (P = 0.019) and left ventricular end-systolic diameter (P = 0.002); but lower left ventricular ejection fraction (P = 0.018). The E group had lesser prevalence of apical ballooning pattern (P = 0.038) than other groups. The P group required more frequent use of inotropics (P = 0.041) and diuretics (P = 0.047) and had significantly longer intensive care unit (P = 0.014) and in-hospital stays (P = 0.001). CONCLUSIONS: The clinical features of TTC are different according to preceding stressor patterns. The TTC group with preceding physical stressors was less likely to have preserved cardiovascular reserve and more likely to require hemodynamic support than other groups. The overall prognosis of TTC is excellent, regardless of triggering stressors.
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Song et al. (2012) conducted an observational in Tako-tsubo cardiomyopathy (n=137). Physical stressors vs. Emotional or no stressors was evaluated on Clinical features, laboratory parameters, and echocardiographic findings. Physical stressors in Tako-tsubo cardiomyopathy were associated with higher rates of cardiogenic shock (P=0.040) and longer in-hospital stays (P=0.001) compared to other triggers.
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