Clinical features and outcomes of takotsubo (stress) cardiomyopathy

Christian Templin, Jelena R. Ghadri, Johanna Diekmann, L. Christian Napp, Dana R. Bataiosu, Milosz Jaguszewski, Victoria L. Cammann, Annahita Sarcon, Verena Geyer, Catharina A. Neumann, Burkhardt Seifert, Jens Hellermann, Moritz Schwyzer, Katharina Eisenhardt, Josef Jenewein, Jennifer Franke, Hugo A. Katus, Christof Burgdorf, Heribert Schunkert, Christian MoellerHolger Thiele, Johann Bauersachs, Carsten Tschöpe, Heinz Peter Schultheiss, Charles A. Laney, Lawrence Rajan, Guido Michels, Roman Pfister, Christian Ukena, Michael Böhm, Raimund Erbel, Alessandro Cuneo, Karl Heinz Kuck, Claudius Jacobshagen, Gerd Hasenfuss, Mahir Karakas, Wolfgang Koenig, Wolfgang Rottbauer, Samir M. Said, Ruediger C. Braun-Dullaeus, Florim Cuculi, Adrian Banning, Thomas A. Fischer, Tuija Vasankari, K. E.Juhani Airaksinen, Marcin Fijalkowski, Andrzej Rynkiewicz, Maciej Pawlak, Grzegorz Opolski, Rafal Dworakowski, Philip MacCarthy, Christoph Kaiser, Stefan Osswald, Leonarda Galiuto, Filippo Crea, Wolfgang Dichtl, Wolfgang M. Franz, Klaus Empen, Stephan B. Felix, Clément Delmas, Olivier Lairez, Paul Erne, Jeroen J. Bax, Ian Ford, Frank Ruschitzka, Abhiram Prasad, Thomas F. Lüscher

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771 Scopus citations

Abstract

Background: The natural history, management, and outcome of takotsubo (stress) cardiomyopathy are incompletely understood. Methods: The International Takotsubo Registry, a consortium of 26 centers in Europe and the United States, was established to investigate clinical features, prognostic predictors, and outcome of takotsubo cardiomyopathy. Patients were compared with age- and sex-matched patients who had an acute coronary syndrome. Results: Of 1750 patients with takotsubo cardiomyopathy, 89.8% were women (mean age, 66.8 years). Emotional triggers were not as common as physical triggers (27.7% vs. 36.0%), and 28.5% of patients had no evident trigger. Among patients with takotsubo cardiomyopathy, as compared with an acute coronary syndrome, rates of neurologic or psychiatric disorders were higher (55.8% vs. 25.7%) and the mean left ventricular ejection fraction was markedly lower (40.7±11.2% vs. 51.5±12.3%) (P<0.001 for both comparisons). Rates of severe in-hospital complications including shock and death were similar in the two groups (P = 0.93). Physical triggers, acute neurologic or psychiatric diseases, high troponin levels, and a low ejection fraction on admission were independent predictors for in-hospital complications. During long-term follow-up, the rate of major adverse cardiac and cerebrovascular events was 9.9% per patient-year, and the rate of death was 5.6% per patient-year. Conclusions: Patients with takotsubo cardiomyopathy had a higher prevalence of neurologic or psychiatric disorders than did those with an acute coronary syndrome. This condition represents an acute heart failure syndrome with substantial morbidity and mortality.

Original languageEnglish (US)
Pages (from-to)929-938
Number of pages10
JournalNew England Journal of Medicine
Volume373
Issue number10
DOIs
StatePublished - Sep 3 2015

ASJC Scopus subject areas

  • Medicine(all)

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    Templin, C., Ghadri, J. R., Diekmann, J., Napp, L. C., Bataiosu, D. R., Jaguszewski, M., Cammann, V. L., Sarcon, A., Geyer, V., Neumann, C. A., Seifert, B., Hellermann, J., Schwyzer, M., Eisenhardt, K., Jenewein, J., Franke, J., Katus, H. A., Burgdorf, C., Schunkert, H., ... Lüscher, T. F. (2015). Clinical features and outcomes of takotsubo (stress) cardiomyopathy. New England Journal of Medicine, 373(10), 929-938. https://doi.org/10.1056/NEJMoa1406761