Stress (Tako-tsubo) cardiomyopathy in critically-ill patients. Issue 2 (1st April 2015)

• Record Type: Journal Article
• Authors: Champion, Sébastien; Belcour, Dominique; Vandroux, David; Drouet, Didier; Gaüzère, Bernard A; Bouchet, Bruno; Bossard, Guillaume; Djouhri, Sabina; Jabot, Julien; Champion, Mathilde; Lefort, Yannick
• Is Part Of: European heart journal. Volume 4:Issue 2(2015:Apr.)
• Page Start: 189
• Page End: 196
• Publication Date: 2015-04-01
• Subjects: brain–heart connection -- catecholamine -- critical illness -- seizures -- stress cardiomyopathy -- Tako-tsubo; 616.1205
• DOI: 10.1177/2048872614547686
• Languages: English
• ISSNs: 2048-8726

Abstract

Abstract: Background: Stress cardiomyopathy (SC) is a transient ventricular dysfunction rarely described in the critical care setting. Objective: To evaluate the mechanisms, incidence, treatment and prognosis of SC. Method: This is a retrospective observational study of every critically-ill patient admitted to the ICU over a period of two years. Results: Among 1314 patients admitted in the ICU, 20 patients (1.5%) were diagnosed with SC. A total of 249 patients experienced cardiogenic shock, whereas 8% were suffering from SC. SC was suspected because of hemodynamic impairment (80% of cases), ECG modifications (15%) and/or dyspnea (15%). SC was apical (typical Tako-tsubo) in 90% and atypical in 10% of cases. Several mechanisms or conditions may explain the occurrence of SC and are may be combined: catecholamine toxicity (45%), psychological stress, seizures or neurological impairment (35%), non-epicardial coronary ischemia (20%) and left ventricular outflow track (LVOT) obstruction (10%). SC could have indirectly caused death by worsening heart failure in three patients and arrhythmias were seen in 40% of patients. SAPS2, renal impairment, malnutrition, norepinephrine infusion and thrombocytopenia were associated with death in the univariate analysis. Catecholamines were required in 85% and intra-aortic balloon pump in 20% of patients. Conclusions: SC is a rare reversible cardiac impairment in the critically-ill patient that can induce arrhythmias and cardiogenic shock. The likely mechanisms are combined: catecholamine toxicity, stress or neurological involvement and less frequently ischemia or LVOT obstruction.