Demographic and Co-Morbid Predictors of Stress (Takotsubo) Cardiomyopathy

      Little is known about the epidemiology of stress (takotsubo) cardiomyopathy (SC). We used a 3-arm case–control study to assess differences in demographic and co-morbid predictors of SC compared to orthopedic controls and myocardial infarction (MI) controls to characterize (1) population-level predictors of SC generally and (2) differences and similarities in determinants of SC compared to MI. We included data on all discharges of patients diagnosed with SC from the 2008 to 2009 National Inpatient Samples and randomly selected 1-to-1 age-matched controls from patients hospitalized with MI and patients hospitalized with joint injuries after trauma. We used McNemar tests to assess differences in demographic characteristics and co-morbidities between patients with SC and controls. There were 24,701 patients with SC in our study. Of patients with SC, 89.0% were women compared to 38.9% of patients with MI and 55.7% of orthopedic controls. Patients with SC were more likely to be white and to reside in wealthier ZIP codes compared to MI and orthopedic controls. Patients with SC were less likely to have cardiovascular risk factors compared to MI and orthopedic controls but were more likely to have had histories of cerebrovascular accidents, drug abuse, anxiety disorders, mood disorders, malignancy, chronic liver disease, and sepsis. In conclusion, demographic and co-morbid predictors of SC differ substantially from those of MI and may be of interest to providers when diagnosing SC. Several co-morbid risk factors predictive of SC may operate by increased catecholamines.
      To read this article in full you will need to make a payment

      Purchase one-time access:

      Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online access
      One-time access price info
      • For academic or personal research use, select 'Academic and Personal'
      • For corporate R&D use, select 'Corporate R&D Professionals'


      Subscribe to American Journal of Cardiology
      Already a print subscriber? Claim online access
      Already an online subscriber? Sign in
      Institutional Access: Sign in to ScienceDirect


        • Maron B.J.
        • Towbin J.A.
        • Thiene G.
        • Antzelevitch C.
        • Corrado D.
        • Arnett D.
        • Moss A.J.
        • Seidman C.E.
        • Young J.B.
        • 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: 1807-1816
        • Prasad A.
        • Lerman A.
        • Rihal C.S.
        Apical ballooning syndrome (tako-tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction.
        Am Heart J. 2008; 155: 408-417
        • Pilgrim T.M.
        • Wyss T.R.
        Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: a systematic review.
        Int J Cardiol. 2008; 124: 283-292
        • Akashi Y.J.
        • Nakazawa K.
        • Sakakibara M.
        • Miyake F.
        • Koike H.
        • Sasaka K.
        The clinical features of takotsubo cardiomyopathy.
        QJM. 2003; 96: 563-573
        • Mitchell J.H.
        • Hadden T.B.
        • Wilson J.M.
        • Achari A.
        • Muthupillai R.
        • Flamm S.D.
        Clinical features and usefulness of cardiac magnetic resonance imaging in assessing myocardial viability and prognosis in takotsubo cardiomyopathy (transient left ventricular apical ballooning syndrome).
        Am J Cardiol. 2007; 100: 296-301
        • Akashi Y.J.
        • Goldstein D.S.
        • Barbaro G.
        • Ueyama T.
        Takotsubo cardiomyopathy: a new form of acute, reversible heart failure.
        Circulation. 2008; 118: 2754-2762
        • Eitel I.
        • von Knobelsdorff-Brenkenhoff F.
        • Bernhard P.
        • Carbone I.
        • Muellerliele K.
        • Aldrovandi A.
        • Francone M.
        • Desch S.
        • Gutberlet M.
        • Strohm O.
        • Schuler G.
        • Schlz-Menger J.
        • Thiele H.
        • Friedrich M.G.
        Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy.
        JAMA. 2011; 306: 277-286
        • Lyon A.R.
        • Rees P.S.
        • Prasad S.
        • Poole-Wilson P.A.
        • Harding S.E.
        Stress (takotsubo) cardiomyopathy—a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning.
        Nat Clin Pract Cardiovasc Med. 2008; 5: 22-29
        • Yaqub Y.
        • Kumar A.
        • Jenkins L.A.
        Case series of takotsubo cardiomyopathy.
        Curr Cardiovasc Risk Rep. 2011; 5: 266-272
        • Rothman K.J.
        • Greenland S.
        Case-control studies.
        in: Rothman K.J. Greenland S. Modern Epidemiology. 2nd ed. Lippincott-Raven, Philadelphia, PA1998: 93-114
        • Charlson M.
        • Szatrowski T.P.
        • Peterson J.
        • Gold J.
        Validation of a combined comorbidity index.
        J Clin Epidemiol. 1994; 47: 1245-1251
        • Abraham J.
        • Mudd J.O.
        • Kapur N.K.
        • Klein K.
        • Champion H.C.
        • Wittstein I.S.
        Stress cardiomyopathy after intravenous administration of catecholamines and beta-receptor agonists.
        J Am Coll Cardiol. 2009; 53: 1320-1325
        • Ako J.
        • Sudhir K.
        • Farouque H.M.O.
        • Honda Y.
        • Fitzgerald P.J.
        Transient left ventricular dysfunction under severe stress: brain-heart relationship revisited.
        Am J Med. 2006; 119: 10-17
        • Palacio C.
        • Nugent K.
        • Alalawi R.
        • Cevik C.
        Severe reversible myocardial depression in a patient with Pseudomonas aeruginosa sepsis suggesting tako-tsubo cardiomyopathy.
        Int J Cardiol. 2009; 135: e16-e19
        • Ohigashi-Suzuki S.
        • Saito Y.
        • Tatsuno I.
        Takotsubo cardiomyopathy associated with sepsis in type 2 diabetes mellitus.
        Am J Emerg Med. 2007; 25: 230-232
        • Geng S.
        • Mullany D.
        • Fraser J.F.
        Takotsubo cardiomyopathy associated with sepsis due to Streptococcus pneumoniae pneumonia.
        Crit Care Resuscitation. 2008; 10: 231-234
        • Anders M.M.
        • Comignani P.D.
        • Couce R.
        • Prini N.
        • Zerega A.R.
        • Santopinto M.
        • Devetach G.
        • Quinonez E.G.
        • Goldaracena N.
        • McCormack L.
        • Mastai R.C.
        Takotsubo cardiomyopathy: A cardiac syndrome mimicking acute myocardial infarction in a liver transplant recipient.
        Cardiol Rev. 2011; 2: 82-85
        • Lee H.R.
        • Hurst R.T.
        • Vargas H.E.
        Transient left ventricular apical ballooning syndrome (takotsubo cardiomyopathy) following orthotopic liver transplantation.
        Liver Transplant. 2007; 13: 1343-1345
        • Tiwari A.K.
        • D'Attellis N.
        Intraoperative left ventricular apical ballooning: transient takotsubo cardiomyopathy during orthotopic liver transplantation.
        J Cardiothorac Vasc Anesth. 2008; 22: 442-445
        • Schnell F.
        • Donal E.
        • Lorho R.
        • Lavoue S.
        • Gacouin A.
        • Compagnon P.
        • Boudjema K.
        • Mabo P.
        • Le Tulzo Y.
        • Camus C.
        Severe left-sided heart failure early after liver transplantation.
        Liver Transplant. 2009; 15: 1296-1305
        • Møller S.
        • Henriksen J.H.
        Cirrhotic cardiomyopathy: a pathophysiological review of circulatory dysfunction in liver disease.
        Heart. 2002; 87: 9-15
        • Henriksen J.H.
        • Moller S.
        • Ring-Larsen H.
        • Christensen N.J.
        The sympathetic nervous system in liver disease.
        J Hepatol. 1998; 29: 328-341
        • Nguyen S.B.
        • Cevik C.
        • Otahbachi M.
        • Kumar A.
        • Jenkins L.A.
        • Nugent K.
        Do comorbid psychiatric disorders contribute to the pathogenesis of tako-tsubo syndrome?.
        Congest Heart Fail. 2009; 15: 31-34
        • Summers M.R.
        • Lennon R.J.
        • Prasad A.
        Pre-morbid psychiatric and cardiovascular diseases in apical ballooning syndrome (tako-tsubo/stress-induced cardiomyopathy): potential pre-disposing factors?.
        J Am Coll Cardiol. 2010; 55: 700-701
        • Wyatt R.J.
        • Portnoy B.
        • Kupfer D.J.
        • Snyder F.
        • Engelman K.
        Resting plasma catecholamine concentrations in patients with depression and anxiety.
        Arch Gen Psychiatry. 1971; 24: 65-70
        • Burgdorf C.
        • Kuowski V.
        • Bonnemeier H.
        • Schunkert H.
        • Radke P.W.
        Long-term prognosis of the transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): focus on malignancies.
        Eur J Heart Fail. 2008; 10: 1015-1019

      Linked Article

      • Takotsubo Cardiomyopathy: Overrepresentation of Cases
        American Journal of CardiologyVol. 111Issue 6
        • Preview
          I read the report “Demographic and Co-Morbid Predictors of Stress (Takotsubo) Cardiomyopathy.”1 The investigators stated that 24,701 cases of stress cardiomyopathy were identified from the 2008 and 2009 Nationwide Inpatient Sample databases2 using International Classification of Diseases, Ninth Revision, Clinical Modification code of 42983. This number of cases appears too large, considering the rarity of the condition. It probably included admissions for acute myocardial infarction, considering that the 2 conditions have very similar clinical presentations.
        • Full-Text
        • PDF