Stress-Induced Cardiomyopathy in a Primary Reference Hospital: Prevalence and Clinical Presentation

Introduction: Stress-induced cardiomyopathy or Takotsubo cardiomyopathy is characterised by a transient localised systolic ventricular dysfunction without epicardial coronary artery disease and is typically provoked by emotional or physical stress. It mainly affects women presenting a greater vulnerability of their hyperactive sympathetic system. Aims: To determine the prevalence, clinical and paraclinical characteristics, complications, in-hospital mortality and recurrence rate of the disease in a primary Swiss reference centre. Methods: Prospective data collection from 2003 to 2009 of hospitalised patients fulfilling the diagnostic criteria of Takotsubo cardiomyopathy: transient ST segment modifications, reversible apical or mid-ventricular akinesia, absence of evidence of epicardial coronary artery disease and other causes of transient left ventricular dysfunction. Results: A total of 31 patients presented with Takotsubo cardiomyopathy. 87% were female and the mean age was 72 ± 13 years. Symptoms included dyspnea or thoracic pain (74%). A trigger factor was present in 65% of the cases. The mean value of peak creatine kinase was 272 U/l and troponins 1.2 μ/L. The electrocardiograms mainly showed a ST-segment elevation in the precordial leads (74%) and a prolonged QTc-interval (77%). The mean left ventricular ejection fraction was 37 ± 10%. Right ventricular involvement was present in one third of the patients and was characterised by higher initial brain natriuretic peptide values. Three patients (10%) presented with midventricular ballooning. All patients completely recovered their cardiac function. Atrial tachyarrhythmias (16%), mainly fibrillation, and cardiogenic shock (13%) were the most frequent complications. The recurrence rate was 6%. Conclusion: The current study is the largest sample of Takotsubo cardiomyopathy patients in a Swiss primary reference centre. The results compare well with international published series. The prevalence was somewhat higher and dyspnea was more often the presenting symptom. This was likely due to the active search of the pathology, a high index of suspicion in front of a suggestive electrocardiogram and a low threshold for performing an echocardiogram in these patients.