Author + information
- Christina Chan, MBChB, MMedSci∗ (, )
- Paul Bridgman, MBChB, MD and
- Richard Troughton, MBChB, PhD
- ↵∗Department of Cardiology, Christchurch Hospital, 2 Riccarton Avenue, Christchurch, Canterbury 4710, New Zealand
We read with interest the recently published case-control study of risk markers and mortality in Takotsubo stress cardiomyopathy (TSC) (1). Tornvall et al. (1) reported that TSC was associated with an increase in mortality rates compared to the control subjects without coronary disease (hazard ratio [HR]: 2.1 for death; 95% confidence interval [CI]: 1.4 to 3.2). This differs from our observation of 21 women who presented with TSC triggered by a powerful earthquake (2). In February 2011, a magnitude 6.3 earthquake struck Christchurch, New Zealand, killing 185 people. Within 4 days of the event, 21 women presented to our center with TSC, diagnosed according to the modified Mayo criteria (3). All women identified the main quake as the precipitant for their symptoms. Obstructive coronary disease was excluded in all but 1 patient, who underwent stenting for a severe circumflex artery disease but exhibited the classic apical ballooning appearance (4). In our cohort of 21 women there have been no deaths after more than 5 years of follow-up.
Our cohort is comparable to that in the study by Tornvall et al. (1), with similar median age (68 ± 15 years of age), cardiovascular risk factors, and patterns of other diseases. One significant difference between our cohort and that reported by Tornvall et al. (1) is the triggering mechanism. Our cohort was highly homogenous in that all had the same emotional trigger. Most other case series are highly heterogeneous, with a wide range of triggers documented. Tornvall et al. (1) concluded from their data that TSC is not benign. We agree with this but highlight the fact that the trigger may be an important determinant of prognosis. This may account for the uniformly favorable outcome in our group of otherwise healthy and psychologically robust women. Further evaluation in larger cohorts is needed, but we propose that the trigger and context for TSC should be considered when evaluating or discussing prognosis.
Please note: Dr. Troughton has received a research grant from St. Jude Medical Inc. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- American College of Cardiology Foundation
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