Natural History of Tako-tsubo Cardiomyopathy.
Chest. 2010 Sep 30;
Authors: Parodi G, Bellandi B, Del Pace S, Barchielli A, Zampini L, Velluzzi S, Carrabba N, Gensini GF, Antoniucci D,
ABSTRACT BACKGROUND: Stress-induced or Tako-Tsubo Cardiomyopathy (TTC) is a rare acute cardiac syndrome characterized by transient left ventricular (LV) dysfunction of uncertain aetiology and outcome. PURPOSES: This study sought to assess the long-term outcome of TTC patients. METHODS: One-hundred and sixteen consecutive patients were prospectively included in the study and observed at long-term follow-up. Primary endpoints were: death, TTC recurrence and hospitalization from any cause. RESULTS: Mean initial LV ejection fraction (EF) at admission was 36Â±9%. Two patients died during hospitalization due to refractory heart failure. All patients who were discharged alive but 1 showed complete LV functional recovery. At follow-up (2.0Â±1.3 years), only 64 (55%) patients were asymptomatic. Rehospitalization rate was high (25%) with chest pain (n=6) and dyspnea (n=5) as the most common causes. Only 2 patients had a recurrence of TTC. Eleven patients died (7 from cardiovascular cause). There was no significant difference in mortality (12% vs 7%; p=0.284) and in the other clinical events between patients with and without severe LV dysfunction at presentation (LV EF â‰¤ 35%). Mortality observed in TTC patients was compared to age and gender specific mortality of the general population using the standardized mortality ratio (SMR) method. The SMR resulted 3.40 (95% CI 1.83-6.34) in TTC population. The only independent predictor of death at Cox analysis was Charlson comorbidity index (HR 1.786; p=0.0001), but initial LV dysfunction degree was not. CONCLUSION: The recurrence of TTC is rare, while recurrences of chest pain or dyspnea are common in TTC patients and frequently lead to hospital readmission. Long-term mortality is higher as compared with the control general population and at least in part related to patient's comorbidities. Initial LV dysfunction severity seems not to impact long-term event rates.
PMID: 20884730 [PubMed - as supplied by publisher]