Korean Circulation Journal

The Korean Society of Cardiology (대한심장학회)
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Clinical Characteristics and Prognostic Factors of Stress-Induced Cardiomyopathy

  • Lee, Jun-Won (Division of Cardiology, Department of Internal Medicine, Wonju College of Medicine, Yonsei University) ;
  • Kim, Jang-Young (Division of Cardiology, Department of Internal Medicine, Wonju College of Medicine, Yonsei University) ;
  • Youn, Young-Jin (Division of Cardiology, Department of Internal Medicine, Wonju College of Medicine, Yonsei University) ;
  • Sung, Joong-Kyung (Division of Cardiology, Department of Internal Medicine, Wonju College of Medicine, Yonsei University) ;
  • Lee, Nam-Seok (Division of Cardiology, Department of Internal Medicine, Wonju College of Medicine, Yonsei University) ;
  • Lee, Kyoung-Hoon (Division of Cardiology, Department of Internal Medicine, Wonju College of Medicine, Yonsei University) ;
  • Yoo, Byung-Su (Division of Cardiology, Department of Internal Medicine, Wonju College of Medicine, Yonsei University) ;
  • Lee, Seung-Hwan (Division of Cardiology, Department of Internal Medicine, Wonju College of Medicine, Yonsei University) ;
  • Yoon, Jung-Han (Division of Cardiology, Department of Internal Medicine, Wonju College of Medicine, Yonsei University) ;
  • Choe, Kyung-Hoon (Division of Cardiology, Department of Internal Medicine, Wonju College of Medicine, Yonsei University)
  • Received : 2009.09.20
  • Accepted : 2009.10.28
  • Published : 2010.06.30
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Abstract

Background and Objectives: Stress-induced cardiomyopathy (SCM) is characterized by a transient left ventricular (LV) dysfunction due to emotional and physical stress. There are limited data about the clinical characteristics in Korean patients. We sought to clarify the clinical features and prognosis in patients with SCM. Subjects and Methods: We reviewed 39 cases diagnosed with SCM in a tertiary hospital. The SCM was diagnosed as: 1) no previous history of cardiac disease, 2) acute onset, 3) regional wall motion abnormality, typically in the takotsubo or inverted takotsubo shape by echocardiography, and 4) no significant stenosis in the coronary angiogram. We evaluated clinical characteristics, biomarkers, and prognosis. Results: Mean age was 61.3${\pm}$16.1 years (female 69%). The triggering factors were physical stress in 32 patients (82%) and emotional stress in 5 patients (13%). The initial symptom was dyspnea (n=18, 46%) rather than chest pain (n=10, 26%). An initial electrocardiogram (EKG) presented T-wave inversion (n=18, 46%), ST-elevation (n=11, 28%), and ST-depression (n=2, 5%). Multivariate logistic regression analysis showed that initial high sensitive C-reactive protein (hs-CRP) {odds ratio (OR) 1.41, 95% confidence interval (CI); 1.02-1.97} and initial left ventricular ejection fraction (LVEF) (OR 0.89, 95% CI; 0.80-0.98) were significantly associated with death or cardiogenic shock, respectively. Conclusion: The major triggering factor of SCM is physical stress due to illness or surgical procedures, and the first manifestation is dyspnea rather than chest pain. Elevated hs-CRP and decreased LVEF at admission were independent risk factors for death or cardiogenic shock.

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References

  1. Bybee KA, Kara T, Prasad A, et al. Systematic review: transient left ventricular apical ballooning: a syndrome that mimics STsegment elevation myocardial infarction. Ann Intern Med 2004; 141:858-65. https://doi.org/10.7326/0003-4819-141-11-200412070-00010
  2. Grawe H, Katoh M, Kuhl HP. Stress cardiomyopathy mimicking acute coronary syndrome: case presentation and review of the literature. Clin Res Cardiol 2006;95:179-85. https://doi.org/10.1007/s00392-006-0346-2
  3. Dote K, Sato H, Tateishi H, Uchida T, Ishihara M. Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases. J Cardiol 1991;21:203-14.
  4. Abe Y, Kondo M, Matsuoka R, Araki M, Dohyama K, Tanio H. Assessment of clinical features in transient left ventricular apical ballooning. J Am Coll Cardiol 2003;41:737-42. https://doi.org/10.1016/S0735-1097(02)02925-X
  5. Lee HH, Gwon HC, Kim BJ, et al. Clinical manifestation of novel stress-induced cardiomyopathy mimicking acute myocardial infarction: single center prospective registry. Korean Circ J 2002; 32:1054-63.
  6. Chang KY, Jeon HK, Chae JS, et al. A novel cardiomyopathy mimicking acute myocardial infarction. Korean Circ J 2002;32:608-12.
  7. Morel O, Sauer F, Imperiale A, et al. Importance of inflammation and neurohumoral activation in Takotsubo cardiomyopathy. J Card Fail 2009;15:206-13. https://doi.org/10.1016/j.cardfail.2008.10.031
  8. Zelinka T, Petrak O, Strauch B, et al. Elevated inflammatory markers in pheochromocytoma compared to other forms of hypertension. Neuroimmunomodulation 2007;14:57-64. https://doi.org/10.1159/000107289
  9. Kurisu S, Sato H, Kawagoe T, et al. Tako-tsubo-like left ventricular dysfunction with ST segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction. Am Heart J 2002;143: 448-55. https://doi.org/10.1067/mhj.2002.120403
  10. Tsuchihashi K, Ueshima K, Uchida T, et al. Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. J Am Coll Cardiol 2001;38:11-8. https://doi.org/10.1016/S0735-1097(01)01316-X
  11. Desmet WJ, Adriaenssens BF, Dens JA. Apical ballooning of the left ventricle: first series in white patients. Heart 2003;89;1027-31. https://doi.org/10.1136/heart.89.9.1027
  12. Bybee KA, Prasad A, Barsness GW, et al. Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am J Cardiol 2004;94:343-6. https://doi.org/10.1016/j.amjcard.2004.04.030
  13. Sharkey SW, Lesser JR, Zenovich AG, et al. Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation 2005;111:472-9. https://doi.org/10.1161/01.CIR.0000153801.51470.EB
  14. Wittstein IS, Thiemann DR, Lima JA, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 2005;352:539-48. https://doi.org/10.1056/NEJMoa043046
  15. Regnante RA, Zuzek RW, Weinsier SB, et al. Clinical characteristics and four-year outcomes of patients in the Rhode Island Takotsubo Cardiomyopathy Registry. Am J Cardiol 2009;103:1015-9. https://doi.org/10.1016/j.amjcard.2008.12.020
  16. Lambert G, Naredi S, Eden E, Rydenhag B, Friberg P. Monoamine metabolism and sympathetic nervous activation following subarachnoid haemorrhage: influence of gender and hydrocephalus. Brain Res Bull 2002;58:77-82. https://doi.org/10.1016/S0361-9230(02)00762-1
  17. Ueyama T, Hano T, Kasamatsu K, Yamamoto K, Tsuruo Y, Nishio I. Estrogen attenuates the emotional stress-induced cardiac responses in the animal model of Tako-tsubo (Ampulla) cardiomyopathy. J Cardiovasc Pharmacol 2003;42(Suppl 1):S117-9. https://doi.org/10.1097/00005344-200312001-00024
  18. Ueyama T, Kasamatsu K, Hano T, Tsuruo Y, Ishikura F. Catecholamines and estrogen are involved in the pathogenesis of emotional stress-induced acute heart attack. Ann N Y Acad Sci 2008; 1148:479-85. https://doi.org/10.1196/annals.1410.079
  19. Park JH, Kang SJ, Song JK, et al. Left ventricular apical ballooning due to severe physical stress in patients admitted to the medical ICU. Chest 2005;128:296-302. https://doi.org/10.1378/chest.128.1.296
  20. Hahn JY, Gwon HC, Park SW, et al. The clinical features of transient left ventricular nonapical ballooning syndrome: comparison with apical ballooning syndrome. Am Heart J 2007;154: 1166-73. https://doi.org/10.1016/j.ahj.2007.08.003
  21. Hurst RT, Askew JW, Reuss CS, et al. Transient midventricular ballooning syndrome: a new variant. J Am Coll Cardiol 2006;48: 579-83. https://doi.org/10.1016/j.jacc.2006.06.015

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