2009 Southern Regional Meeting Abstracts

Purpose of Study: Tako-tsubo syndrome is a transient cardiomyopathy characterized by apical ballooning visualized by ventriculography. This syndrome is usually precipitated by acute emotional stress and is also referred to as a stress cardiomyopathy.
Methods Used: We analyzed the impact of emotional stress on clinical variables, echocardiographic characteristics, and short term outcomes in tako-tsubo patients identified during a 12 month period. Retrospective chart review was done with IRB approval.
Summary of Results: 11 patients presented with tako-tsubo syndrome (1 man, 10 women) during Jan07 - Dec07. Mean age was 53.8 + 12.6 years, lower than previous reports. 27% of patients were less than 50 years of age. Patients were divided into those presenting with predisposing emotional stress (6/11, 54.5%) and those with no obvious stressors (5/11, 45.5%). An emotional stressor was defined as an emotionally distressful event (death of family member, family feud, anxiety) occurring within preceding 30 days. Mean troponin T level in stress group was 0.57 (range-0.12-1.18) compared to 0.51 (range-0.03-2.06) in non-stress related group. Mean creatinine was 0.7 + 0.2 mg/dl. Apical ballooning was uniformly present; anterior wall hypokinesia/dyskinesia was present in 67% of patients (4/6) in emotional stress group and 80% of the non-stress group (4/5). The mean LVEDP was 15.8+ 8.1 mmHg in whole cohort (mean 14.5 in the stressed group and 17.8 in non-stressed group). Infection, either sepsis or pneumonia, was present in 40% of the non-stress group (2/5) and 17% of the emotional stress group (1/6). Emotional stress was positively correlated with length of stay (p=0.04), the presence of ST-segment changes on ECG (66.7 % vs. 40%, p=0.42), and higher ejection fractions (p=0.012).
Conclusions: Although stress plays a major role in tako-tsubo syndrome, we did identify non emotional stress-related cases (45 %) with idiopathic tako-tsubo syndrome found in 3/11 (27%) patients. Patient with emotional stress had more ST segment changes, higher EF (p=0.012), lower LVEDP (14.5 vs. 17.8 mmHg), and longer length of stay (p=0.04) as compared to non-stress related patients. To best of our knowledge, this is first study which reports the clinical, echocardiographic and outcome differences in emotional stress vs. non-stress related tako-tsubo syndrome.