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Chest. 2011 Apr;139(4):887-892. doi: 10.1378/chest.10-1041. Epub 2010 Sep 30.

Natural history of tako-tsubo cardiomyopathy.

Author information

1
Department of Cardiology, Careggi Hospital, University of Florence, Florence, Italy. Electronic address: parodiguido@gmail.com.
2
Department of Cardiology, Careggi Hospital, University of Florence, Florence, Italy.
3
Epidemiology Unit, Azienda Sanitaria Firenze, Florence, Italy.

Abstract

BACKGROUND:

Stress-induced or tako-tsubo cardiomyopathy (TTC) is a rare acute cardiac syndrome characterized by transient left ventricular (LV) dysfunction of uncertain cause and outcome. This study sought to assess the long-term outcome of patients with TTC.

METHODS:

One-hundred sixteen consecutive patients were prospectively included in the study and observed at long-term follow-up. Primary end points were death, TTC recurrence, and hospitalization from any cause.

RESULTS:

Mean initial LV ejection fraction (LVEF) at admission was 36% ± 9%. Two patients died of refractory heart failure during hospitalization. Of the patients who were discharged alive all except one showed complete LV functional recovery. At follow-up (2.0 ± 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 two patients had a recurrence of TTC. Eleven patients died (seven from cardiovascular cause). There was no significant difference in mortality (12% vs 7%; P = .284) and in the other clinical events between patients with and without severe LV dysfunction at presentation (LVEF ≤ 35%). Mortality observed in patients with TTC was compared with age and sex-specific mortality of the general population using the standardized mortality ratio (SMR) method. The SMR was 3.40 (95% CI, 1.83-6.34) in the TTC population. The only independent predictor of death at Cox analysis was Charlson comorbidity index (hazard ratio, 1.786; P = .0001), but the degree of initial LV dysfunction was not an independent predictor of death.

CONCLUSIONS:

The recurrence of TTC is rare, but recurrences of chest pain or dyspnea are common in patients with TTC 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 patients' comorbidities. Initial LV dysfunction severity does not seem to impact long-term event rates.

PMID:
20884730
DOI:
10.1378/chest.10-1041
[Indexed for MEDLINE]

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