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Type: Journal article
Title: Dissociation between severity of takotsubo cardiomyopathy and presentation with shock or hypotension
Author: Chong, C.
Neil, C.
Nguyen, T.
Stansborough, J.
Law, G.
Singh, K.
Horowitz, J.
Citation: Clinical Cardiology (Hoboken): an indexed and peer-reviewed journal for advances in the treatment of cardiovascular disease, 2013; 36(7):401-406
Publisher: Clinical Cardiology Publ Co
Issue Date: 2013
ISSN: 0160-9289
Statement of
Cher-Rin Chong, Christopher J. Neil, Thanh H. Nguyen, Jeanette Stansborough, Gin Way Law, Kuljit Singh and John D. Horowitz
Abstract: BACKGROUND: Takotsubo cardiomyopathy (TTC) is increasingly well-recognized as a cause of chest-pain syndromes, especially in aging females. The most common complications of TTC occur in the first 24 hours post onset of symptoms and include shock and/or arrhythmias. HYPOTHESIS: We tested the hypothesis that the severity of early hypotension in TTC reflects the extent of myocardial involvement and dysfunction. METHODS: In 80 consecutive TTC patients, correlates of blood pressure on the day of admission were sought via univariate followed by multivariate analysis. RESULTS: Mean systolic blood pressure (SBP) on day 1 was 120±24 (SD) mm Hg. During the first 3 days of admission, 39% of patients had SBP <90mm Hg, and 9% died and/or required intra-aortic balloon pump insertion. The extent of release of N-terminal pro-brain natriuretic peptide, with its potential correlate of associated vasodilator activity, varied inverselywith pulmonary-artery saturation, a measure of cardiac output. However, there was no significant relationship between normetanephrine release and SBP. On multivariate analyses there was no significant relationship between SBP and (1) wall-motion score index (as an index of left-ventricular systolic dysfunction) or (2) T2 enhancement on cardiac magnetic resonance imaging and peak N-terminal pro-brain natriuretic peptide (as indices of myocardial inflammation). CONCLUSIONS: Although severe hypotension and shock occur commonly during acute stages of TTC, these complications are multifactorial in origin, probably representing a combination of impaired inotropic state and vasodilatation. Importantly, initial hypotension does not imply severe left ventricular inflammation or systolic dysfunction.
Keywords: Humans
Shock, Cardiogenic
Natriuretic Peptide, Brain
Peptide Fragments
Magnetic Resonance Imaging
Patient Admission
Intra-Aortic Balloon Pumping
Severity of Illness Index
Multivariate Analysis
Risk Factors
Chi-Square Distribution
Predictive Value of Tests
Blood Pressure
Ventricular Function, Left
Time Factors
Aged, 80 and over
Middle Aged
Takotsubo Cardiomyopathy
Rights: © 2013 Wiley Periodicals, Inc.
DOI: 10.1002/clc.22129
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