Clinical characteristics and prognostic factors of stress-induced cardiomyopathy

Junwon Lee, Jang Young Kim, Youngjin Youn, Joong Kyung Sung, Nam Seok Lee, Kyoung Hoon Lee, Byungsu Yoo, Seunghwan Lee, Junghan Yoon, Kyung Hoon Choe

Research output: Contribution to journalArticle

20 Citations (Scopus)

Abstract

Background and Objectives: Stress-induced cardiomyopathy (SCM) is characterized by a transient left ventricular (LV) dysfunction due to emotional and physical stress. There are limited data about the clinical characteristics in Korean patients. We sought to clarify the clinical features and prognosis in patients with SCM. Subjects and Methods: We reviewed 39 cases diagnosed with SCM in a tertiary hospital. The SCM was diagnosed as: 1) no previous history of cardiac disease, 2) acute onset, 3) regional wall motion abnormality, typically in the takotsubo or inverted takotsubo shape by echocardiography, and 4) no significant stenosis in the coronary angiogram. We evaluated clinical characteristics, biomarkers, and prognosis. Results: Mean age was 61.3±16.1 years (female 69%). The triggering factors were physical stress in 32 patients (82%) and emotional stress in 5 patients (13%). The initial symptom was dyspnea (n=18, 46%) rather than chest pain (n=10, 26%). An initial electrocardiogram (EKG) presented T-wave inversion (n=18, 46%), ST-elevation (n=11, 28%), and ST-depression (n=2, 5%). Multivariate logistic regression analysis showed that initial high sensitive C-reactive protein (hs-CRP) {odds ratio (OR) 1.41, 95% confidence interval (CI); 1.02-1.97} and initial left ventricular ejection fraction (LVEF) (OR 0.89, 95% CI; 0.80-0.98) were significantly associated with death or cardiogenic shock, respectively. Conclusion: The major triggering factor of SCM is physical stress due to illness or surgical procedures, and the first manifestation is dyspnea rather than chest pain. Elevated hs-CRP and decreased LVEF at admission were independent risk factors for death or cardiogenic shock.

Original languageEnglish
Pages (from-to)277-282
Number of pages6
JournalKorean Circulation Journal
Volume40
Issue number6
DOIs
Publication statusPublished - 2010 Jun 1

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Takotsubo Cardiomyopathy
Cardiogenic Shock
Chest Pain
Psychological Stress
Stroke Volume
Dyspnea
C-Reactive Protein
Electrocardiography
Odds Ratio
Confidence Intervals
Coronary Stenosis
Left Ventricular Dysfunction
Tertiary Care Centers
Echocardiography
Heart Diseases
Angiography
Biomarkers
Logistic Models
Regression Analysis

All Science Journal Classification (ASJC) codes

  • Internal Medicine
  • Cardiology and Cardiovascular Medicine

Cite this

Lee, Junwon ; Kim, Jang Young ; Youn, Youngjin ; Sung, Joong Kyung ; Lee, Nam Seok ; Lee, Kyoung Hoon ; Yoo, Byungsu ; Lee, Seunghwan ; Yoon, Junghan ; Choe, Kyung Hoon. / Clinical characteristics and prognostic factors of stress-induced cardiomyopathy. In: Korean Circulation Journal. 2010 ; Vol. 40, No. 6. pp. 277-282.
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title = "Clinical characteristics and prognostic factors of stress-induced cardiomyopathy",
abstract = "Background and Objectives: Stress-induced cardiomyopathy (SCM) is characterized by a transient left ventricular (LV) dysfunction due to emotional and physical stress. There are limited data about the clinical characteristics in Korean patients. We sought to clarify the clinical features and prognosis in patients with SCM. Subjects and Methods: We reviewed 39 cases diagnosed with SCM in a tertiary hospital. The SCM was diagnosed as: 1) no previous history of cardiac disease, 2) acute onset, 3) regional wall motion abnormality, typically in the takotsubo or inverted takotsubo shape by echocardiography, and 4) no significant stenosis in the coronary angiogram. We evaluated clinical characteristics, biomarkers, and prognosis. Results: Mean age was 61.3±16.1 years (female 69{\%}). The triggering factors were physical stress in 32 patients (82{\%}) and emotional stress in 5 patients (13{\%}). The initial symptom was dyspnea (n=18, 46{\%}) rather than chest pain (n=10, 26{\%}). An initial electrocardiogram (EKG) presented T-wave inversion (n=18, 46{\%}), ST-elevation (n=11, 28{\%}), and ST-depression (n=2, 5{\%}). Multivariate logistic regression analysis showed that initial high sensitive C-reactive protein (hs-CRP) {odds ratio (OR) 1.41, 95{\%} confidence interval (CI); 1.02-1.97} and initial left ventricular ejection fraction (LVEF) (OR 0.89, 95{\%} CI; 0.80-0.98) were significantly associated with death or cardiogenic shock, respectively. Conclusion: The major triggering factor of SCM is physical stress due to illness or surgical procedures, and the first manifestation is dyspnea rather than chest pain. Elevated hs-CRP and decreased LVEF at admission were independent risk factors for death or cardiogenic shock.",
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Clinical characteristics and prognostic factors of stress-induced cardiomyopathy. / Lee, Junwon; Kim, Jang Young; Youn, Youngjin; Sung, Joong Kyung; Lee, Nam Seok; Lee, Kyoung Hoon; Yoo, Byungsu; Lee, Seunghwan; Yoon, Junghan; Choe, Kyung Hoon.

In: Korean Circulation Journal, Vol. 40, No. 6, 01.06.2010, p. 277-282.

Research output: Contribution to journalArticle

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T1 - Clinical characteristics and prognostic factors of stress-induced cardiomyopathy

AU - Lee, Junwon

AU - Kim, Jang Young

AU - Youn, Youngjin

AU - Sung, Joong Kyung

AU - Lee, Nam Seok

AU - Lee, Kyoung Hoon

AU - Yoo, Byungsu

AU - Lee, Seunghwan

AU - Yoon, Junghan

AU - Choe, Kyung Hoon

PY - 2010/6/1

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N2 - Background and Objectives: Stress-induced cardiomyopathy (SCM) is characterized by a transient left ventricular (LV) dysfunction due to emotional and physical stress. There are limited data about the clinical characteristics in Korean patients. We sought to clarify the clinical features and prognosis in patients with SCM. Subjects and Methods: We reviewed 39 cases diagnosed with SCM in a tertiary hospital. The SCM was diagnosed as: 1) no previous history of cardiac disease, 2) acute onset, 3) regional wall motion abnormality, typically in the takotsubo or inverted takotsubo shape by echocardiography, and 4) no significant stenosis in the coronary angiogram. We evaluated clinical characteristics, biomarkers, and prognosis. Results: Mean age was 61.3±16.1 years (female 69%). The triggering factors were physical stress in 32 patients (82%) and emotional stress in 5 patients (13%). The initial symptom was dyspnea (n=18, 46%) rather than chest pain (n=10, 26%). An initial electrocardiogram (EKG) presented T-wave inversion (n=18, 46%), ST-elevation (n=11, 28%), and ST-depression (n=2, 5%). Multivariate logistic regression analysis showed that initial high sensitive C-reactive protein (hs-CRP) {odds ratio (OR) 1.41, 95% confidence interval (CI); 1.02-1.97} and initial left ventricular ejection fraction (LVEF) (OR 0.89, 95% CI; 0.80-0.98) were significantly associated with death or cardiogenic shock, respectively. Conclusion: The major triggering factor of SCM is physical stress due to illness or surgical procedures, and the first manifestation is dyspnea rather than chest pain. Elevated hs-CRP and decreased LVEF at admission were independent risk factors for death or cardiogenic shock.

AB - Background and Objectives: Stress-induced cardiomyopathy (SCM) is characterized by a transient left ventricular (LV) dysfunction due to emotional and physical stress. There are limited data about the clinical characteristics in Korean patients. We sought to clarify the clinical features and prognosis in patients with SCM. Subjects and Methods: We reviewed 39 cases diagnosed with SCM in a tertiary hospital. The SCM was diagnosed as: 1) no previous history of cardiac disease, 2) acute onset, 3) regional wall motion abnormality, typically in the takotsubo or inverted takotsubo shape by echocardiography, and 4) no significant stenosis in the coronary angiogram. We evaluated clinical characteristics, biomarkers, and prognosis. Results: Mean age was 61.3±16.1 years (female 69%). The triggering factors were physical stress in 32 patients (82%) and emotional stress in 5 patients (13%). The initial symptom was dyspnea (n=18, 46%) rather than chest pain (n=10, 26%). An initial electrocardiogram (EKG) presented T-wave inversion (n=18, 46%), ST-elevation (n=11, 28%), and ST-depression (n=2, 5%). Multivariate logistic regression analysis showed that initial high sensitive C-reactive protein (hs-CRP) {odds ratio (OR) 1.41, 95% confidence interval (CI); 1.02-1.97} and initial left ventricular ejection fraction (LVEF) (OR 0.89, 95% CI; 0.80-0.98) were significantly associated with death or cardiogenic shock, respectively. Conclusion: The major triggering factor of SCM is physical stress due to illness or surgical procedures, and the first manifestation is dyspnea rather than chest pain. Elevated hs-CRP and decreased LVEF at admission were independent risk factors for death or cardiogenic shock.

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