Epidemiological and clinical profile of the patients treated in Clinical Hospital Centre Rijeka with discharge diagnosis of takotsubo cardiomyopathy: single-centre experience

    Authors

    Keywords

    clinical profile, female patients, takotsubo cardiomyopathy

    DOI

    https://doi.org/10.15836/ccar2016.536

    Full Text

    Introduction: Takotsubo cardiomyopathy (TTC) has been described, for the past 25 years, as the specific form of left ventricular abnormality without sings of coronary arteries obstruction (1, 2). In 2006, the American Heart Association has recognized TTC as a form of acquired cardiomyophaty (3). Aim: To demonstrate epidemiological and clinical profile of the patients with a discharge diagnosis of TTC, treated in the Department of Cardiovascular Diseases, Clinical Hospital Centre Rijeka. Patients and Methods: Retrospective analysis, with the discharge diagnosis of TTC, in the period 2012-2016 (20 female patients). Data has been collected from the Department’s database. Results: Median age was 62 (range 46 to 92) years. Average length of hospitalization was 4-5 days. On the arrival, blood pressure was 134±21/82±13 mmHg and puls was 90±23 per minute. From the medical history: 60% of the patients had hyperlipoproteinemia, 55% arterial hypertension, 30% diabetes, 25% neoplasms, 10% chronic obstructive pulmonary disease, 10% hypothyroidism, and 5% had chronic cerebrovascular disease. Emotional triggers were: panic attack (30%), personal loss (15%), anger/conflict (10%), and interpersonal conflict (5%). Physical triggers were perioperative anxiety (10%) and malignancy (5%). Troponin T level (TnT) on the arrival was 399.7±393.6 ng/L, whilst on the day of discharge it was 176.8±243.0 ng/L. ECG showed ST-segment elevation in the precordial leads in the 55% of the patients, and in the inferior leads in 15%. Negative T wave was present in the precordial and/or inferior leads in the 80% of the patients. The ejection fraction (EF) value (ultrasound) was 44±13%. 40% of patients had preserved (≥50%) EF, 25% had mid-range (40-49%) EF, and 35% of patients had reduced (<40%) EF. Apical ballooning of the left ventricle was present among 95% of the patients. All patients underwent coronarography, and no signs of obstructive coronary disease were found. 10 patients (50%) underwent ventriculography, and 8 (80%) of them showed apical ballooning. Conclusion: Clinical presentation of TTC is impossible to distinguish from the acute myocardial infarction, but it’s crucial to be taken into observation among certain patient profile. Those are females in the postmenopause with evident emotional/physical trigger, moderately increased TnT, left ventricle disfunction and normal coronarography.

    Literature

    1. 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. https://pubmed.ncbi.nlm.nih.gov/1841907/
    2. Madhavan M, Prasad A. Proposed Mayo Clinic criteria for the diagnosis of Tako-Tsubo cardiomyopathy and long-term prognosis. Herz. 2010;35:240–3. https://doi.org/10.1007/s00059-010-3339-x
    3. Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, et al. American Heart Association; Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; Council on Epidemiology and Prevention. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation. 2006;113(14):1807–16. https://doi.org/10.1161/CIRCULATIONAHA.106.174287
    Cardiologia Croatica
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    Epidemiological and clinical profile of the patients treated in Clinical Hospital Centre Rijeka with discharge diagnosis of takotsubo cardiomyopathy: single-centre experience

    Extended Abstract
    Issue10-11
    Published
    Pages536-537
    PDF via DOIhttps://doi.org/10.15836/ccar2016.536
    clinical profile
    female patients
    takotsubo cardiomyopathy

    Authors

    Ivan VuksanORCIDUniversity of Rijeka School of Medicine, Rijeka, Croatia
    Andrej BelančićORCIDUniversity of Rijeka School of Medicine, Rijeka, Croatia
    Luka VranićORCIDUniversity of Rijeka School of Medicine, Rijeka, Croatia
    Nikolina JurjevićORCIDCommunity Health Centre Rijeka, Primorsko-goranska County, Rijeka, Croatia
    Tamara HlačaUniversity of Rijeka School of Medicine, Rijeka, Croatia
    CaputORCIDUniversity of Rijeka School of Medicine, University Hospital Centre Rijeka, Rijeka, Croatia
    Alen RužićORCIDUniversity of Rijeka School of Medicine, University Hospital Centre Rijeka, Rijeka, Croatia
    Luka ZaputovićORCIDUniversity of Rijeka School of Medicine, University Hospital Centre Rijeka, Rijeka, Croatia
    Teodora ZaninovićUniversity of Rijeka School of Medicine, Rijeka, Croatia
    Jurjević*ORCIDUniversity of Rijeka School of Medicine, University Hospital Centre Rijeka, Rijeka, Croatia

    *Correspondence email: teazj@net.hr

    Full Text

    Introduction: Takotsubo cardiomyopathy (TTC) has been described, for the past 25 years, as the specific form of left ventricular abnormality without sings of coronary arteries obstruction (1, 2). In 2006, the American Heart Association has recognized TTC as a form of acquired cardiomyophaty (3). Aim: To demonstrate epidemiological and clinical profile of the patients with a discharge diagnosis of TTC, treated in the Department of Cardiovascular Diseases, Clinical Hospital Centre Rijeka.

    Patients and Methods: Retrospective analysis, with the discharge diagnosis of TTC, in the period 2012-2016 (20 female patients). Data has been collected from the Department’s database.

    Results: Median age was 62 (range 46 to 92) years. Average length of hospitalization was 4-5 days. On the arrival, blood pressure was 134±21/82±13 mmHg and puls was 90±23 per minute. From the medical history: 60% of the patients had hyperlipoproteinemia, 55% arterial hypertension, 30% diabetes, 25% neoplasms, 10% chronic obstructive pulmonary disease, 10% hypothyroidism, and 5% had chronic cerebrovascular disease. Emotional triggers were: panic attack (30%), personal loss (15%), anger/conflict (10%), and interpersonal conflict (5%). Physical triggers were perioperative anxiety (10%) and malignancy (5%). Troponin T level (TnT) on the arrival was 399.7±393.6 ng/L, whilst on the day of discharge it was 176.8±243.0 ng/L. ECG showed ST-segment elevation in the precordial leads in the 55% of the patients, and in the inferior leads in 15%. Negative T wave was present in the precordial and/or inferior leads in the 80% of the patients. The ejection fraction (EF) value (ultrasound) was 44±13%. 40% of patients had preserved (≥50%) EF, 25% had mid-range (40-49%) EF, and 35% of patients had reduced (<40%) EF. Apical ballooning of the left ventricle was present among 95% of the patients. All patients underwent coronarography, and no signs of obstructive coronary disease were found. 10 patients (50%) underwent ventriculography, and 8 (80%) of them showed apical ballooning.

    Conclusion: Clinical presentation of TTC is impossible to distinguish from the acute myocardial infarction, but it’s crucial to be taken into observation among certain patient profile. Those are females in the postmenopause with evident emotional/physical trigger, moderately increased TnT, left ventricle disfunction and normal coronarography.

    Literature

    1. 1.
      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.PubMed
    2. 2.
      Madhavan M, Prasad A. Proposed Mayo Clinic criteria for the diagnosis of Tako-Tsubo cardiomyopathy and long-term prognosis. Herz. 2010;35:240–3.DOI
    3. 3.
      Maron BJ, Towbin JA, Thiene G, Antzelevitch C, Corrado D, Arnett D, et al. American Heart Association; Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; Council on Epidemiology and Prevention. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation. 2006;113(14):1807–16.DOI