Sébastien Champion1, Dominique Belcour2, David Vandroux2, Didier Drouet2, Bernard A Gaüzère2, Bruno Bouchet2, Guillaume Bossard2, Sabina Djouhri2, Julien Jabot2, Mathilde Champion3, Yannick Lefort2.
Abstract
BACKGROUND: Stress cardiomyopathy (SC) is a transient ventricular dysfunction rarely described in the critical care setting.
OBJECTIVE: To evaluate the mechanisms, incidence, treatment and prognosis of SC.
METHOD: This is a retrospective observational study of every critically-ill patient admitted to the ICU over a period of two years.
RESULTS: Among 1314 patients admitted in the ICU, 20 patients (1.5%) were diagnosed with SC. A total of 249 patients experienced cardiogenic shock, whereas 8% were suffering from SC. SC was suspected because of hemodynamic impairment (80% of cases), ECG modifications (15%) and/or dyspnea (15%). SC was apical (typical Tako-tsubo) in 90% and atypical in 10% of cases. Several mechanisms or conditions may explain the occurrence of SC and are may be combined: catecholamine toxicity (45%), psychological stress, seizures or neurological impairment (35%), non-epicardial coronary ischemia (20%) and left ventricular outflow track (LVOT) obstruction (10%). SC could have indirectly caused death by worsening heart failure in three patients and arrhythmias were seen in 40% of patients. SAPS2, renal impairment, malnutrition, norepinephrine infusion and thrombocytopenia were associated with death in the univariate analysis. Catecholamines were required in 85% and intra-aortic balloon pump in 20% of patients.
CONCLUSIONS: SC is a rare reversible cardiac impairment in the critically-ill patient that can induce arrhythmias and cardiogenic shock. The likely mechanisms are combined: catecholamine toxicity, stress or neurological involvement and less frequently ischemia or LVOT obstruction. © The European Society of Cardiology 2014.
BACKGROUND: Stress cardiomyopathy (SC) is a transient ventricular dysfunction rarely described in the critical care setting.
OBJECTIVE: To evaluate the mechanisms, incidence, treatment and prognosis of SC.
METHOD: This is a retrospective observational study of every critically-ill patient admitted to the ICU over a period of two years.
RESULTS: Among 1314 patients admitted in the ICU, 20 patients (1.5%) were diagnosed with SC. A total of 249 patients experienced cardiogenic shock, whereas 8% were suffering from SC. SC was suspected because of hemodynamic impairment (80% of cases), ECG modifications (15%) and/or dyspnea (15%). SC was apical (typical Tako-tsubo) in 90% and atypical in 10% of cases. Several mechanisms or conditions may explain the occurrence of SC and are may be combined: catecholamine toxicity (45%), psychological stress, seizures or neurological impairment (35%), non-epicardial coronary ischemia (20%) and left ventricular outflow track (LVOT) obstruction (10%). SC could have indirectly caused death by worsening heart failure in three patients and arrhythmias were seen in 40% of patients. SAPS2, renal impairment, malnutrition, norepinephrine infusion and thrombocytopenia were associated with death in the univariate analysis. Catecholamines were required in 85% and intra-aortic balloon pump in 20% of patients.
CONCLUSIONS: SC is a rare reversible cardiac impairment in the critically-ill patient that can induce arrhythmias and cardiogenic shock. The likely mechanisms are combined: catecholamine toxicity, stress or neurological involvement and less frequently ischemia or LVOT obstruction. © The European Society of Cardiology 2014.
Entities:
Keywords:
Tako-tsubo; brain–heart connection; catecholamine; critical illness; seizures; stress cardiomyopathy
Mesh：
Substances：
Year: 2014
PMID： 25202025 DOI： 10.1177/2048872614547686
Source DB: PubMed Journal: Eur Heart J Acute Cardiovasc Care ISSN： 2048-8726