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• W2018453609 abstract "The incidence and type of stroke in the setting of takotsubo cardiomyopathy (TC) can vary, depending on the patient population being studied [ 1 de Gregorio C. Grimaldi P. Lentini C. Left ventricular thrombus formation and cardioembolic complications in patients with Takotsubo-like syndrome: a systematic review. Int J Cardiol. Dec 17 2008; 131: 18-24 Abstract Full Text Full Text PDF PubMed Scopus (121) Google Scholar , 2 Yoshimura S. Toyoda K. Ohara T. et al. Takotsubo cardiomyopathy in acute ischemic stroke. Ann Neurol. Nov 2008; 64: 547-554 Crossref PubMed Scopus (163) Google Scholar , 3 Mitsuma W. Kodama M. Ito M. et al. Thromboembolism in Takotsubo cardiomyopathy. Int J Cardiol. Feb 18 2010; 139: 98-100 Abstract Full Text Full Text PDF PubMed Scopus (41) Google Scholar , 4 Tobar R. Rotzak R. Rozenman Y. Apical thrombus associated with Takotsubo cardiomyopathy in a young woman. Echocardiography. May 2009; 26: 575-580 Crossref PubMed Scopus (14) Google Scholar , 5 Lee W. Profitis K. Barlis P. Van Gaal W.J. Stroke and Takotsubo cardiomyopathy: is there more than just cause and effect?. Int J Cardiol. Apr 14 2011; 148: e37-e39 Abstract Full Text Full Text PDF PubMed Scopus (7) Google Scholar ]. For this reason, we sought to investigate the occurrence of TC together with stroke at our institution (Mayo Clinic, Scottsdale, Arizona). To do this, we identified all patients with a diagnosis of TC per ICD-9 (International Classification of Diseases, Ninth Edition) (ICD-9 code 429.83; October 1, 2006, to October 31, 2011) (Table 1) or apical ballooning syndrome (ICD-9 code 419.89; January 1, 2006, to September 30, 2006) in a retrospective analysis of the electronic medical records. These criteria identified 122 unique cases of TC, of whom 110 were treated in our hospital (Table 2, Table 3). Twelve patients were excluded because their initial diagnosis and treatment were provided at another institution. Table 1Characteristics of 110 patients with takotsubo cardiomyopathy. Characteristic Value, no. (%) a Values are number (percentage) unless indicated otherwise. Age at time of TC diagnosis, mean ± SD, year 70.1 ± 11.8 Female sex, No. (%) 92 (83.6) BMI, mean ± SD 24.5 ± 4.7 Race White 105 (95) Black 2 (2) Asian 1 (1) Hispanic 2 (2) Risk factors Hypertension 74 (67) Diabetes mellitus 18 (16) Dyslipidemia 63 (57) Chronic kidney disease 12 (11) Coronary artery disease 23 (21) PVD (including cerebrovascular disease) 21 (19) Stroke 18 (16) Atrial fibrillation 21 (19) Tobacco use Lifelong nonsmoker 36 (33) Past smoker 53 (48) Current smoker 19 (17) Pack-year history, mean ± SD 33.0 ± 22.3 Home medications Anticoagulant 12 (11) Clopidogrel 3 (3) Aspirin 29 (26) Antiarrhythmic 9 (8) Diuretic 30 (27) Statin/lipid lowering 34 (31) ACE inhibitor/ARB 27 (25) Calcium channel blocker 18 (16) β-Blocker 29 (26) Other 32 (29) None 13 (12) Abbreviations: ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; BMI, body mass index (weight in kilograms divided by height in meters squared [kg/m2]); PVD, peripheral vascular disease; and TC, takotsubo cardiomyopathy. a Values are number (percentage) unless indicated otherwise. Open table in a new tab Table 2Index hospital course of 110 patients with takotsubo cardiomyopathy. Characteristic Value, no. (%) a Values are number (percentage) unless indicated otherwise. Presenting signs and symptoms ECG changes 28 (25) Seizure activity 5 (5) Headache 2 (2) Hemiparesis 5 (5) Altered mental status 16 (15) Dyspnea 51 (46) Heart failure 3 (3) Diaphoresis 10 (9) Radiation of pain 21 (19) Chest pain/discomfort 58 (53) Cardiac biomarkers (ng/mL) Peak troponin T 0.37 ± 0.45 Peak CK-MB 17.7 ± 32.3 Ejection fraction, mean±SD, % 36.8 ± 11.8 TC wall motion abnormality Apical 84 (76) Mid 22 (20) Basal 4 (4) Thrombus present 2 (2) Patients with stroke 7 (6) Death during index hospitalization 2 (2) Medications at discharge Anticoagulant 31 (28) Clopidogrel 8 (7) Aspirin 64 (58) β-Blocker 80 (73) Antiarrhythmic 12 (11) Diuretic 35 (32) Statin 58 (53) Calcium channel blocker 14 (13) ACE inhibitor/ARB 56 (51) Other 27 (25) Abbreviations: ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; CK-MB, creatine kinase MB; and ECG, electrocardiogram. a Values are number (percentage) unless indicated otherwise. Open table in a new tab Table 3Post-hospitalization course of 66 patients with takotsubo cardiomyopathy. Characteristic Value, no. (%) a Values are number (percentage) unless indicated otherwise. Subsequent clinical events (n = 66) None noted 49 (74) Subsequent stroke 0 Coronary artery disease 12 (18) Congestive heart failure 6 (9) Subsequent TC episodes 4 (6) Days until TC documented as resolved (n = 64) 33.5 ± 31.8 Follow-up EF by echocardiogram, % (n = 64) 62.0 ± 6.7 Abbreviations: EF, ejection fraction; and TC, takotsubo cardiomyopathy. a Values are number (percentage) unless indicated otherwise. Open table in a new tab Abbreviations: ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; BMI, body mass index (weight in kilograms divided by height in meters squared [kg/m2]); PVD, peripheral vascular disease; and TC, takotsubo cardiomyopathy. Abbreviations: ACE, angiotensin-converting enzyme; ARB, angiotensin receptor blocker; CK-MB, creatine kinase MB; and ECG, electrocardiogram. Abbreviations: EF, ejection fraction; and TC, takotsubo cardiomyopathy." @default.
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• W2018453609 title "Takotsubo cardiomyopathy and stroke" @default.
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