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Mortality risk in patients with takotsubo stress cardiomyopathy similar to those with CAD
Despite a low CV risk profile, patients with takotsubo stress cardiomyopathy had an excess mortality risk similar to patients with CAD, according to results from a registry study.
The researchers analyzed 505 patients with takotsubo stress cardiomyopathy (mean age, 67 years; 87.5% women) from the Swedish Coronary Angiography and Angioplasty Register and compared their risk markers and mortality with matched control populations with (n = 1,010) and without (n = 1,007) CAD.
Compared with controls with CAD, participants with takotsubo stress cardiomyopathy were less likely to smoke (P < .01), less likely to be treated for hypertension (P < .01) and hyperlipidemia (P < .01) and less likely to have type 1 or type 2 diabetes (P < .01 for both), the researchers wrote. Those with takotsubo stress cardiomyopathy had higher income and education levels than those with CAD (P < .01 for both).
Compared with controls without CAD, participants with takotsubo stress cardiomyopathy were more likely to smoke (P < .01), less likely to be treated for hypertension (P < .01) and hyperlipidemia (P <.01), no more likely to have type 1 (P = .05) or type 2 (P = .32) diabetes while having higher income (P < .01) and a similar level of education (P = .29), according to the researchers.
Compared with patients with CAD, those with takotsubo stress cardiomyopathy were less likely to have MI or angina (P < .01 for both), more likely to have chronic obstructive pulmonary disease (P < .01), migraine (P = .02), affective disorders (P = .02) or anxiety disorders (P = .02), no more likely to have HF (P = .14) or atrial fibrillation (P = .74), less likely to use beta-blockers (P < .01) and more likely to use beta-2-adrenergic agonist agents (P < .01), according to the researchers.
Participants with takotsubo stress cardiomyopathy were more likely than controls without CAD to have MI and angina (P < .01), less likely to have AF (P < .01), more likely to have affective disorders (P < .01) and to abuse alcohol (P < .01), less likely to take beta-blockers (P < .01) and diuretics (P = .02) and more likely to take beta-2-adrenergic agonist agents (P < .01).
Mortality similar to CAD
Per Tornvall, MD, PhD, from the department of clinical science and education, Södersjukhuset, Karolinska Institutet, Stockholm, and colleagues found that those with takotsubo stress cardiomyopathy had similar mortality rates to the control group with CAD (log-rank P = .46) but higher rates than the control group without CAD (HR = 2.1; 95% CI, 1.4-3.2; log-rank P < .01). The mortality risk for takotsubo stress cardiomyopathy vs. no CAD was similar to that for CAD vs. no CAD (HR = 2.5; 95% CI, 1.8-3.3), they wrote.
The results did not change after adjustment for CAD risk factors and takotsubo stress cardiomyopathy risk markers.
“The findings of increased risk associated with [beta-2-adrenergic] agonist agents together with stress related to affective disorders emphasize the pathogenic role of sympathetic stimulation,” Tornvall and colleagues wrote. The mortality results emphasize “the urgent need for studies on optimal treatment of [takotsubo stress cardiomyopathy],” they wrote.
Medication quandary
In a related editorial, Christian Templin, MD, PhD, from the department of cardiology, University Heart Center, University Hospital, Zurich, and colleagues wrote that “the conclusion of the authors to generally avoid beta-agonists to prevent potential [takotsubo syndrome] events is not advisable, considering the prevalence of chronic obstructive pulmonary disease and asthma vs. the incidence of [takotsubo syndrome].”
They wrote that because of that and the retrospective nature of the study, “all analysis of medication in the present study should be interpreted with caution.” – by Erik Swain
Disclosure: The researchers, Templin and colleagues report no relevant financial disclosures.