Differential characteristics of takotsubo cardiomyopathy according to clinical context

Background/Aims: Takotsubo cardiomyopathy (TC) occurs in diverse clinical settings and generally has a favorable prognosis; however, little is known about its characteristics and outcomes across different contexts. We evaluated the clinical features and in-hospital mortality of TC according to clinical setting. Methods: A total of 153 patients diagnosed with TC from 2008 to 2020 were included. Patients were classified as having primary TC (presenting as the primary reason for care, n = 31) or secondary TC (n = 122), which was further subdivided into infection (n = 58), medical/surgical illness (n = 38), and stroke (n = 26). Results: Prior cerebrovascular accident was more frequent in the infection and stroke groups. Length of hospital stay, intenincludsive care unit stay, and ventilator use were greatest in the stroke group, whereas inotropic agent use was most frequent in the infection group. N-terminal pro-B-type natriuretic peptide levels differed across groups, with the highest levels observed in the primary form (p = 0.025). Echocardiographic parameters were generally comparable, although left atrial diameter was larger in the primary form and smaller in the stroke group. Overall in-hospital mortality was 13.1% and occurred exclusively in secondary TC. Mortality was highest in the infection group, but the difference was not statistically significant (p = 0.053). In multivariate regression analysis, age, bacteremia, and follow-up right ventricular systolic pressure (RVSP) were independently associated with in-hospital mortality. Conclusions: The prognosis of primary form of TC was excellent, while the patients with infection had higher tendency of in-hospital death. Age, bacteremia, and follow-up RVSP were independent predictors of in-hospital death in TC patients.