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Journal Club 9 September 2015


Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy





The natural history, management, and outcome of takotsubo (stress) cardiomyopathy
are incompletely understood.


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.


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.


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

Supplementary Material

The following supplementary material is provided by Dr Koitka:

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