Observational study in Takotsubo cardiomyopathy

Arantes, C; Gaspar, A; Salgado, A; Martins, J; Abreu, G; Galvão-Braga, C; Rocha, S; Correia, A

http://hdl.handle.net/10400.23/916

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INTRODUCTION: Takotsubo cardiomyopathy (TC) is a still rarely diagnosed clinical syndrome, which is characterized by transient cardiac dysfunction with reversible wall motion abnormalities. AIM: Determine the demographic characteristics, clinical presentation and prognosis of patients with TC. METHODS: Retrospective study of 39 patients admitted for TC in a cardiology center during a period of 3 years. RESULTS: In the population studied, the mean age was 67.15±12.01 years and women were predominant.The most frequent comorbidities were hypertension (76.9%), dyslipidemia (51.3%), psychiatric illness (23.1%) and diabetes mellitus (12.8%). The emotional stress was the most common triggering event (n=10), however, in 17 patients we were not able to identify any precipitating factor. Cardinal symptoms which led to admission, were acute chest pain (n=28) and dyspnoea (n=15). The most common ECG findings were ST segment elevation (n=21), inversion of the T wave (n=21) and QTc prolongation (n=22). All patients had typical wall motion abnormalities in the echocardiography and/or ventriculography. The mean ejection fraction was 35.59±5.54%. The most common in-hospital complication was acute heart failure (n=16, 41%), whereas 3 patients developed cardiogenic shock. The presence of moderate to severe LVS dysfunction (p=0.048) and higher levels of C reactive protein (p=0.02) and pBNP (p=0.042) were associated with the development of acute heart failure. Rhythm disturbances occurred in 3 patients and there was only one non-cardiovascular death. At follow-up at 6 months all patients showed recovery of LVS function; there was one recurrence and 3 deaths from non-cardiovascular causes. CONCLUSION: According to the literature, our review shows higher prevalence of TC in women and a clinical and electrocardiographic presentation similar to the picture of an acute coronary syndrome. In the acute phase, the TC is not necessarily a benign entity, because we observed a high prevalence of acute heart failure.