The clinical features and emotional stressors in korean patients with tako-tsubo cardiomyopathy

Abstract

Background. Tako-tsubo cardiomyopathy (TTC) is typically triggered by an acute emotional or physical stress events. Aim of this study was to investigate the impact of emotional stressors on clinical features, laboratory parameters, electrocardiographic and echocardiographic findings in patients with TTC. Methods. Of 103 patients enrolled from the TTC registry database, fifteen patients had emotional triggers (E group), and 88 patients had physical triggers or no triggers (other group). Results. Most clinical presentations and in-hospital courses were similar between the groups. However, E group had higher prevalence of chest pain (87 versus 42 %, P = 0.001), palpitation (27 versus 6%, P = 0.008), whereas other group had higher prevalence of cardiogenic shock (35 versus 7%, P = 0.027). E group had significantly higher corrected QT intervals (median, 477.5 versus 438 ms, P = 0.001), and left ventricular ejection fraction (LVEF) (mean, 45.7 versus 39.6%, P = 0.001), but lower hs-CRP (median, 0.1 versus 3.3 mg/L, P = 0.001), CK-MB (median, 5.5 versus 11.9 ng/mL, P = 0.047), troponin-I (median, 1.0 versus 3.2 ng/mL, P = 0.011), and NT-proBNP levels (median, 2145 versus 4939 pg/mL, P = 0.020). Other group required more frequent hemodynamic support and had significantly longer intensive care unit (median, 3 versus 1 days, P = 0.005) and in-hospital (median, 17 versus 3 days, P = 0.001) durations. Conclusion. The clinical features of TTC are different between groups with and without preceding emotional stressors. The TTC group with preceding emotional stressors was more likely to have preserved cardiovascular reserve and lesser likely to require hemodynamic support than other group although the entire prognosis of TTC is excellent regardless of triggering stressors.

Figure 1

Preceding stressful events of 103 patients with TTC. Emotional stressors were documented in 15% of patients, whereas physical stressors were documented in 67% of patients and 18% of patients had no triggering stressor.