Takotsubo Cardiomyopathy in the Intensive Care Unit

Abstract

Background Takotsubo cardiomyopathy (TC) is a syndrome of reversible left ventricular dysfunction triggered by psychological or physical stress. The pathogenesis is related to high levels of circulating catecholamines. Critically ill patients may be particularly at risk due to the use of inotropes and vasopressors. The incidence in the Australian intensive care (ICU) population is not known. Methods We performed a prospective cohort study in a large ICU in Sydney. The primary objective was to establish the incidence of a TC pattern on echocardiography (echo). Secondary objectives were determining baseline characteristics, comorbidities and risk factors for developing TC; relationship between inotrope and vasopressor dose and developing the syndrome; and the effect of TC on both ICU and hospital mortality and length of stay (LOS). We assessed the utility of point-of-care echos performed by ICU doctors as a screening tool. Patients were screened within 24 hours of admission to the ICU and enrolled if they were receiving mechanical ventilation, receiving >5mcg/min of noradrenaline or receiving renal replacement therapy. Exclusion criteria were a primary diagnosis of TC or acute myocardial infarction, or admission to ICU post cardiac surgery. An echo was performed within 48 hours of enrolment and assessed at a later date for the presence of a TC pattern and diagnostic quality. Results A total of 116 trial patients were enrolled, of whom 4 had an incident diagnosis of TC on echo (3.5%, 95% CI 0.9% to 8.6%). There was no significant difference in the ICU or hospital LOS with a median ICU LOS in both groups of 6 days (p 0.982) and hospital LOS 16 days in the non-TC group compared to 15 days in the TC group (p 0.874). The ICU mortality in patients in the TC group was 0% compared to 17% in the non-TC group (p 0.999). Conclusion We found a low incident diagnosis of TC on echo and it was not associated with an excess mortality.