Takotsubo Cardiomyopathy and Trauma: The Role of Injuries as Physical Stressors

Abstract

Introduction: Physical stressors are common predisposing factors for takotsubo cardiomyopathy (TTC). However, the role of traumatic injuries in TTC has not been well defined. This study describes the characteristics of TTC in the broad spectrum of traumatic injuries using the information available in the National Trauma Data Bank (NTDB).

Materials and methods: This retrospective study analyzed trauma patients ≥ 18 years old in the NTDB, from 2007 to 2018, with a diagnosis of TTC.

Results: A total of 95 TTC diagnoses were found. The median age was 68 years old (interquartile range: 55-80). Patients were predominantly female (67.4%), white (88.4%), and sustained blunt mechanisms of injury (90.5%). Penetrating trauma was most common in males (16%). Most diagnoses were related to extremity trauma (53.7%), followed by head injury (26.3%). The most common severity scores were Glasgow Coma Scale (GCS) > 13 or < 8, and Injury Severity Score (ISS) < 15 or > 25. Males more commonly presented with GCS < 8 (68%), ISS > 25 (33%), high intensive care unit (ICU) admission rate (77.4%), and mechanical ventilation (51.6%). The median duration of the mechanical ventilation was eight days for both sexes. The ICU length of stay (LOS) was six days with a hospital LOS of nine days and a trend toward a longer LOS in males. The in-hospital mortality rate was 11.7% for both sexes.

Conclusions: TTC in traumatic injuries is common at both ends of the severity spectrum and has different sex distribution. TTC patients are predominantly females and have more commonly extremity trauma than head injury. Males are more severely injured and under mechanical ventilation.

Keywords: national trauma data bank; physical stressors; stress cardiomyopathy; takotsubo cardiomyopathy; trauma.

Figure 1. (A) The number of reported TTC diagnoses by year. (B) Count of TTC diagnoses reported by race. One data point was missing from the National Trauma Data Bank. (C) Count of TTC diagnoses reported by primary insurance type.

TTC = takotsubo cardiomyopathy.

Figure 2. (A) Count of reported mechanisms of injury type for those with TTC. (B) Count of reported ISS by categorical grouping. Six data points were missing from the NTDB in those with TTC. (C) Count of reported GCS scores by categorical grouping. Three data points were missing from the NTDB in those with TTC.

TTC = takotsubo cardiomyopathy; NTDB = National Trauma Data Bank; ISS = Injury Severity Score; GCS = Glasgow Coma Scale.

Figure 3. Probability (stratified by sex) of being discharged alive from the hospital (A), being discharged alive from the ICU (B), and being extubated (C).

Shaded areas represent 95% confidence intervals.