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Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy
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BACKGROUND: The natural history, management, and outcome of takotsubo (stress) cardiomyopathy are incompletely understood. METHODS: The International Takotsubo Registry, a consortium of 26 centers in Europe and the United States, was established to investigate clinical features, prognostic predictors, and outcome of takotsubo cardiomyopathy. Patients were compared with age- and sex-matched patients who had an acute coronary syndrome. RESULTS: Of 1750 patients with takotsubo cardiomyopathy, 89.8% were women (mean age, 66.8 years). Emotional triggers were not as common as physical triggers (27.7% vs. 36.0%), and 28.5% of patients had no evident trigger. Among patients with takotsubo cardiomyopathy, as compared with an acute coronary syndrome, rates of neurologic or psychiatric disorders were higher (55.8% vs. 25.7%) and the mean left ventricular ejection fraction was markedly lower (40.7±11.2% vs. 51.5±12.3%) (P<0.001 for both comparisons). Rates of severe in-hospital complications including shock and death were similar in the two groups (P=0.93). Physical triggers, acute neurologic or psychiatric diseases, high troponin levels, and a low ejection fraction on admission were independent predictors for in-hospital complications. During long-term follow-up, the rate of major adverse cardiac and cerebrovascular events was 9.9% per patient-year, and the rate of death was 5.6% per patient-year. CONCLUSIONS: Patients with takotsubo cardiomyopathy had a higher prevalence of neurologic or psychiatric disorders than did those with an acute coronary syndrome. This condition represents an acute heart failure syndrome with substantial morbidity and mortality. (Funded by the Mach-Gaensslen Foundation and others; ClinicalTrials.gov number, NCT01947621.).
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“In severe cases of cytokine storm, renal failure, acute liver injury or cholestasis, and a stress-related or takotsubo-like cardiomyopathy can also develop.”
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Metadata
- Authors
- Templin, C., Ghadri, J. R., Diekmann, J., Napp, L. C., Bataiosu, D. R., Jaguszewski, M., Cammann, V. L., Sarcon, A., Geyer, V., Neumann, C. A., Seifert, B., Hellermann, J., Schwyzer, M., Eisenhardt, K., Jenewein, J., Franke, J., Katus, H. A., Burgdorf, C., Schunkert, H., Moeller, C., Thiele, H., Bauersachs, J., Tschöpe, C., Schultheiss, H.-P., Laney, C. A., Rajan, L., Michels, G., Pfister, R., Ukena, C., Böhm, M., Erbel, R., Cuneo, A., Kuck, K.-H., Jacobshagen, C., Hasenfuss, G., Karakas, M., Koenig, W., Rottbauer, W., Said, S. M., Braun-Dullaeus, R. C., Cuculi, F., Banning, A., Fischer, T. A., Vasankari, T., Airaksinen, K. E. J., Fijalkowski, M., Rynkiewicz, A., Pawlak, M., Opolski, G., Dworakowski, R., MacCarthy, P., Kaiser, C., Osswald, S., Galiuto, L., Crea, F., Dichtl, W., Franz, W. M., Empen, K., Felix, S. B., Delmas, C., Lairez, O., Erne, P., Bax, J. J., Ford, I., Ruschitzka, F., Prasad, A., & Lüscher, T. F.
- Affiliations
- University of Zurich (CH)
- Medizinische Hochschule Hannover (DE)
- University Hospital Zurich (CH)
- Heidelberg University (DE)
- University of Kentucky (US)
- University of Cologne (DE)
- Universität Hamburg (DE)
- Universität Ulm (DE)
- Winterthur Museum Garden and Library (US)
- University of Turku (FI)
- Medical University of Warsaw (PL)
- University of Cambridge (GB)
- University of Basel (CH)
- Università Cattolica del Sacro Cuore (IT)
- Innsbruck Medical University (AT)
- Universität Greifswald (DE)
- Leiden University (NL)
- ORCID
- Templin, Christian
- Ghadri, Jelena R.
- Diekmann, Johanna
- Napp, L. Christian
- Jaguszewski, Milosz
- Cammann, Victoria L.
- Seifert, Burkhardt
- Schwyzer, Moritz
- Jenewein, Josef
- Franke, Jennifer
- Katus, Hugo A.
- Burgdorf, Christof
- Schunkert, Heribert
- Bauersachs, Johann
- Tschöpe, Carsten
- Schultheiss, Heinz-Peter
- Pfister, Roman
- Ukena, Christian
- Böhm, Michael
- Cuneo, Alessandro
- Hasenfuss, Gerd
- Karakas, Mahir
- Rottbauer, Wolfgang
- Braun-Dullaeus, Ruediger C.
- Cuculi, Florim
- Banning, Adrian
- Vasankari, Tuija
- Rynkiewicz, Andrzej
- Opolski, Grzegorz
- MacCarthy, Philip
- Kaiser, Christoph
- Osswald, Stefan
- Galiuto, Leonarda
- Crea, Filippo
- Dichtl, Wolfgang
- Empen, Klaus
- Felix, Stephan B.
- Delmas, Clément
- Lairez, Olivier
- Bax, Jeroen J.
- Ford, Ian
- Ruschitzka, Frank
- Prasad, Abhiram
- Lüscher, Thomas F.
- Venue
- New England Journal of Medicine
- Publisher
- Massachusetts Medical Society
- Published
- 2015-09-03
- Volume
- 373
- Issue
- 10
- Pages
- 929-938
- ISSN
- 0028-4793 (ISSN-L)
- 1533-4406
- OpenAlex
- W2110733697
- Cited by
- 2,595
- References
- 30
- Citations by year
- 2026: 208 · 2025: 229 · 2024: 224 · 2023: 240 · 2022: 270 · 2021: 273 · 2020: 270 · 2019: 266 · 2018: 228 · 2017: 182 · 2016: 182 · 2015: 18
- FWCI
- 147.86
- Type
- journal article
- Language
- en
- Open access
- bronze
- doi.org
- Locations
- New England Journal of Medicine (publishedVersion)
- PubMed (publishedVersion)
- Kölner Universitäts PublikationsServer (Universität zu Köln) (publishedVersion)
- Zurich Open Repository and Archive (University of Zurich) (acceptedVersion, other-oa)
- GRO (submittedVersion, cc-by)
- Data Archiving and Networked Services (DANS) (submittedVersion)
- Leiden Repository (Leiden University) (submittedVersion)
- GoeScholar The Publication Server of the Georg-August-Universität Göttingen (Georg-August-Universität Göttingen) (submittedVersion, cc-by)
- IRIS Research product catalog (Sapienza University of Rome) (submittedVersion)
- mediaTUM (Technical University of Munich) (submittedVersion)
- Zurich Open Repository and Archive (University of Zurich) (submittedVersion, other-oa)
- Zurich Open Repository and Archive (University of Zurich)
- Funders
- National Science Foundation
- Eli Lilly and Company
- Pfizer
- AstraZeneca
- Edwards Lifesciences
- Foundation for Cardiovascular Research
- Boston Scientific Corporation
- Mach-Gaensslen Foundation of Canada
- Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung
- Schweizerische Herzstiftung
- Herzstiftung Olten
- Universität Zürich
- Servier
- St. Jude Medical
- Abbott Vascular
- Biosense Webster
- Topics
- Health Sciences › Medicine › Cardiology and Cardiovascular Medicine › Takotsubo Cardiomyopathy and Associated Phenomena
- Health Sciences › Medicine › Psychiatry and Mental health › Psychosomatic Disorders and Their Treatments
- Health Sciences › Medicine › Infectious Diseases › Viral Infections and Immunology Research
- Keywords
- takotsubo cardiomyopathy, acute coronary syndrome, left ventricular ejection fraction, in-hospital complications, major adverse cardiac and cerebrovascular events, mortality, troponin
- MeSH terms
- Aged, Angiotensin-Converting Enzyme Inhibitors, Echocardiography, Electrocardiography, Female, Follow-Up Studies, Heart Ventricles, Humans, Male, Middle Aged, Registries, Retrospective Studies, Proportional Hazards Models, Ventricular Function, Left, Kaplan-Meier Estimate, Acute Coronary Syndrome, Takotsubo Cardiomyopathy, Angiotensin Receptor Antagonists
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