Distinctive clinical characteristics according to age and gender in apical ballooning syndrome (takotsubo/stress cardiomyopathy): An analysis focusing on men and young women

Background: Apical ballooning syndrome (ABS) predominantly affects postmenopausal women. There is a paucity of data regarding ABS in men and young women. The aim of this study was to compare the clinical characteristics and outcomes of men and young women (<50 y) to older women (≥50 y). Methods & Results: We retrospectively reviewed the records of 224 patients and divided them into men (n = 12), young women (n = 12), and older women (n = 200). Older women were further subdivided into those who were and were not on hormone replacement therapy (HRT) at the time of presentation. Men were more likely to present after a physical trigger (100% vs 46%; P =.009), have lower ejection fractions (30.1 ± 8.0% vs 40 ± 13.9%; P =.04), and have greater need for mechanical ventilation (67% vs 17%; P <.0001) compared with older women. Younger women were more likely to have a history of psychiatric disorders (75% vs 24%; P =.0001) at presentation and a higher rate of recurrence (16% vs 3%; P =.017) compared with older women. Of the older women, 15 developed ABS while on chronic HRT. Those without HRT were more likely to require mechanical hemodynamic (7.7% and 0%; P =.002) and ventilatory (18.1% and 0%; P =.017) support compared with older women who were on HRT. Conclusions: Men appeared to develop ABS as a consequence of a physical trigger, whereas young women had a higher rate of psychiatric comorbidities and a greater propensity for recurrence. Treatment with HRT in older women does not preclude the development of ABS.