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“Diabetes paradox” in Takotsubo Cardiomyopathy

2016; Elsevier BV; Volume: 224; Linguagem: Inglês

10.1016/j.ijcard.2016.08.136

1874-1754

Verena Bill, Ibrahim El‐Battrawy, Michael Behnes, Stefan Baumann, Tobias Becher, Elif Elmas, Ursula Hoffmann, Darius Haghi, Christian Fastner, Jürgen Kuschyk, Theano Papavassiliu, Martin Borggrefe, İbrahim Akın,

Cardiac Structural Anomalies and Repair

Takotsubo Cardiomyopathy (TC) is an acute reversible cardiomyopathy characterized by transient left (LV) ventricular apical ballooning with the absence of significant coronary artery disease [ [1] Korlakunta H.L. Thambidorai S.K. Denney S.D. Khan I.A. Transient left ventricular apical ballooning: a novel heart syndrome. Int. J. Cardiol. 2005; 102: 351-353 Abstract Full Text Full Text PDF PubMed Scopus (31) Google Scholar ]. However, detailed knowledge regarding aetiology of TC remains indistinct. Assuming that microvascular dysfunction or vasospasm leads to the typical apical ballooning, an abnormal response to catecholamines may take important part of the pathophysiology [ [2] Wittstein I.S. Thiemann D.R. Lima J.A.C. Baughman K.L. Schulman S.P. Gerstenblith G. Wu K.C. Rade J.J. Bivalacqua T.J. Champion H.C. Neurohumoral features of myocardial stunning due to sudden emotional stress. N. Engl. J. Med. 2005; 352: 539-548 Crossref PubMed Scopus (2371) Google Scholar ]. There is a hint that diabetes mellitus is a relevant comorbidity influencing the outcome of TC. We evaluated the influence of diabetes mellitus on long-term outcome in of 114 consecutive patients suffering from TC in a single center large cohort from January 2003 to September 2015 (for Baseline characteristics and primary endpoints Table 1). This study was conducted in compliance with the Declaration of Helsinki with regard to investigations in human subjects and the study protocol was approved by the Ethics Committee of University Medical Centre Mannheim. Table 1Baseline characteristics and primary endpoint events in one-year-follow-up of 114 patients suffering from TC in coexistence or absence of diabetes mellitus. Variables Non-diabetes Diabetes P value * P value, comparison between diabetes mellitus and non-diabetes-mellitus group one-year follow-up. (n = 88) (n = 26) Baseline characteristics of 114 patients Demographics Age, mean ± SD 67 ± 11 67 ± 13 0.88 Female n (%) 73 (83.0) 22 (84.6) 0.84 Symptoms, n (%) Chest pain 45 (51.1) 13 (50.0) 0.92 Dyspnea 31 (35.2) 12 (46.2) 0.31 ECG data, n (%) ST-elevation 29 (32.9) 5 (19.2) 0.18 Echocardiography data Left ventricular ejection fraction % 38.7 38.3 0.84 Right ventricular involvement, n (%) 20 (22.7) 6 (23.1) 0.97 Comorbidities, n (%) Smoking 26 (29.5) 10 (38.5) 0.39 Hypertension 47 (53.4) 0.07 Obesity 19 (29.2) 19 (73.1)12 (66.7) <0.01 Primary endpoint events in one-year-follow-up Life-threatening arrhythmia 11 (12.5) 2 (7.7) 0.50 Thromboembolic event 13 (14.8) 1 (3.8) 0.14 Death 13 (14.8) 1 (3.8) 0.14 Cardiopulmonary resuscitation 7 (7.9) 2 (7.7) 0.97 Recurrence 0 (0) 0 (0) 1.00 Stroke 1 (1.1) 0 (0) 1.00 Rehospitalisation due to heart failure 0 (0) 0 (0) 1.00 ECG, electrocardiogram; SD, standard deviation. Bold data indicates significant < 0.05. P value, comparison between diabetes mellitus and non-diabetes-mellitus group one-year follow-up. Open table in a new tab ECG, electrocardiogram; SD, standard deviation. Bold data indicates significant < 0.05.