Per Tornvall1, Olov Collste2, Ewa Ehrenborg3, Hans Järnbert-Petterson2. 1. Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Söder-sjukhuset, Stockholm, Sweden. Electronic address: per.tornvall@ki.se. 2. Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Söder-sjukhuset, Stockholm, Sweden. 3. Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden.
Abstract
BACKGROUND: Takotsubo stress cardiomyopathy (TSC) is a syndrome characterized by transient myocardial dysfunction with unknown etiology. Although recent studies have suggested that the syndrome is associated with comorbidity and has a dismal prognosis, there is a lack of comprehensive data describing the epidemiology and prognosis of TSC. OBJECTIVES: This study compared risk markers and mortality in patients with TSC with that of individuals with or without coronary artery disease (CAD). METHODS: Patients with TSC and control subjects were identified from the Swedish Coronary Angiography and Angioplasty Register between 2009 and 2013 and linked with the Swedish national patient registry, cause of death registry, prescription drug registry, and education and income registries. RESULTS: Patients with TSC were characterized by a low cardiovascular risk factor profile but with increased chronic obstructive pulmonary disease, migraine, and affective disorders. The use of beta-blockers was less common but use of β2-adrenergic agonist agents was more common in patients with TSC compared with either of the control groups. Being a patient with TSC was associated with a hazard ratio of 2.1 for death compared with the control subjects without CAD (95% confidence interval: 1.4 to 3.2). This was similar to the excess mortality risk seen among the CAD control subjects compared with control subjects without CAD (hazard ratio: 2.5; 95% confidence interval: 1.8 to 3.3). These associations remained significant after adjusting for CAD risk factors and risk markers for TSC. CONCLUSIONS: The findings of increased risk associated with β2-adrenergic agonist agents together with stress related to affective disorders emphasize the pathogenic role of sympathetic stimulation. The prognosis regarding mortality is worse than in control subjects without CAD and similar to patients with CAD emphasizing the urgent need for studies on optimal treatment of TSC.
BACKGROUND:Takotsubo stress cardiomyopathy (TSC) is a syndrome characterized by transient myocardial dysfunction with unknown etiology. Although recent studies have suggested that the syndrome is associated with comorbidity and has a dismal prognosis, there is a lack of comprehensive data describing the epidemiology and prognosis of TSC. OBJECTIVES: This study compared risk markers and mortality in patients with TSC with that of individuals with or without coronary artery disease (CAD). METHODS:Patients with TSC and control subjects were identified from the Swedish Coronary Angiography and Angioplasty Register between 2009 and 2013 and linked with the Swedish national patient registry, cause of death registry, prescription drug registry, and education and income registries. RESULTS:Patients with TSC were characterized by a low cardiovascular risk factor profile but with increased chronic obstructive pulmonary disease, migraine, and affective disorders. The use of beta-blockers was less common but use of β2-adrenergic agonist agents was more common in patients with TSC compared with either of the control groups. Being a patient with TSC was associated with a hazard ratio of 2.1 for death compared with the control subjects without CAD (95% confidence interval: 1.4 to 3.2). This was similar to the excess mortality risk seen among the CAD control subjects compared with control subjects without CAD (hazard ratio: 2.5; 95% confidence interval: 1.8 to 3.3). These associations remained significant after adjusting for CAD risk factors and risk markers for TSC. CONCLUSIONS: The findings of increased risk associated with β2-adrenergic agonist agents together with stress related to affective disorders emphasize the pathogenic role of sympathetic stimulation. The prognosis regarding mortality is worse than in control subjects without CAD and similar to patients with CAD emphasizing the urgent need for studies on optimal treatment of TSC.
Authors: Horacio Medina de Chazal; Marco Giuseppe Del Buono; Lori Keyser-Marcus; Liangsuo Ma; F Gerard Moeller; Daniel Berrocal; Antonio Abbate Journal: J Am Coll Cardiol Date: 2018-10-16 Impact factor: 24.094
Authors: Caroline Scally; Hassan Abbas; Trevor Ahearn; Janaki Srinivasan; Alice Mezincescu; Amelia Rudd; Nicholas Spath; Alim Yucel-Finn; Raif Yuecel; Keith Oldroyd; Ciprian Dospinescu; Graham Horgan; Paul Broadhurst; Anke Henning; David E Newby; Scott Semple; Heather M Wilson; Dana K Dawson Journal: Circulation Date: 2019-03-26 Impact factor: 29.690