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ȣ - 540539 354 |
| Different Features of ‘Typical’ and ‘Atypical’ Types of Stress-induced Cardiomyopathy |
| 전북대학교 의학전문대학원 내과학교실 심장내과 |
| 이선화, 김원호, 박윤지, 김선희, 송민주, 이상록, 이경석, 채제건, 고재기 |
Background: Stress-induced cardiomyopathy (SCM) is characterized by apical ballooning on echocardiography, but some of SCM patients show inverted takotsubo pattern.
Methods: We investigated 76 patients that were diagnosed as SCM by echocardiography, clinical situation, and conventional or computed tomographic coronary angiography. They were divided into 2 groups: ‘typical’ (=apical or takotsubo) (n=65) and ‘atypical’ (=non-apical or inverted takotsubo) (n=11) groups.
Results: Mean age of overall patients was 69.6±12.2 years. Sixty-one patients (80.3%) were female. Patients of the ‘atypical’ group were younger than those of the ‘typical’ group (55.6±14.3 years vs. 72.0±10.1, p<0.001). Physical stress was more frequent in the ‘atypical’ group (36.4%) than in the ‘typical’ group (6.2%, p=0.003). All patients in non-apical group were asymptomatic, but 23.1% of apical SCM patients experienced chest pain (p=0.075). On electrocardiogram, ST-segment elevation (51.6% vs. 11.1%, p=0.023) and T-wave inversion (95.3% vs. 44.4%, p<0.001) were more frequent in the apical group than in the non-apical group. Although heart rate at the time of diagnosis was comparable in both groups, corrected QT interval of the ‘typical’ group was significantly longer than that of the ‘atypical’ group (538.1±50.7 ms vs. 491.2±60.3 ms, p=0.014). Left ventricular ejection fraction at the time of diagnosis and at recovery phase, wall motion score index, and right ventricular involvement rate were comparable in the 2 groups (table).
Conclusion: Patients with non-apical SCM showed not only ‘atypical’ echocardiographic findings, but also ‘atypical’ clinical and electrocardiographic manifestations. Therefore, careful consideration is needed to diagnose ‘atypical’ type of SCM.
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‘Typical’
(=apical or takotsubo)
(n=65) |
‘Atypical’
(=non-apical or inverted takotsubo)
(n=11) |
P value |
|
Age (years) |
72.0±10.1 |
55.6±14.3 |
<0.001 |
|
Female (%) |
81.5 |
72.7 |
0.497 |
|
Stress (%)
Physical : non-physical
Chest pain (%)
CHF (%)
In-hospital death (%) |
6.2% : 93.8%
23.1
49.2
1.5 |
36.4% : 63.6%
0
36.4
0 |
0.003
0.075
0.429
0.679 |
|
Risk factors (%)
HTN
DM
Dyslipidemia
Smoking |
35.4
26.2
47.7
4.6 |
9.1
18.2
18.2
0 |
0.083
0.572
0.068
0.467 |
|
Laboratory findings
WBC (/μL)
Hemoglobin (g/dL)
Hematocrit (%)
Creatinine (mg/dL)
Troponin I, peak (ng/mL)
NT-pro-BNP, peak (pg/mL) |
11,308±7,010
11.0±2.2
33.0±6.5
1.41±1.21
3.76±4.81
14,929.3±13,283.8 |
11,408±5,549
11.7±1.5
34.1±3.8
1.09±0.93
6.09±10.14
17,085.5±13,982.9 |
0.397
0.318
0.430
0.411
0.492
0.672 |
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Electrocardiographic findings
NSR (%)
ST-segment elevation (%)
T-wave inversion (%)
Heart rate (bpm)
QT inveral (ms)
Corrected QT interval (ms) |
76.6
51.6
95.3
103.3±22.3
448.0±65.3
538.1±50.7 |
100
11.1
44.4
103.8±25.5
410.0±90.8
491.2±60.3 |
0.103
0.023
<0.001
0.983
0.256
0.014 |
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Echocardiographic findings
Initial LV EF (%)
Follow-up LV EF (%)
Wall motion score index
RV involvement (%) |
39.2±8.4
54.5±4.5
2.05±0.30
6.2 |
38.1±13.5
55.5±3.8
2.00±0.46
9.1 |
0.722
0.522
0.685
0.716 |
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