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“Ballooning” patterns in takotsubo cardiomyopathy reflect different clinical backgrounds and outcomes: a BOREAS-TCM study

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Whether different patterns of ventricular ballooning in takotsubo cardiomyopathy (TCM) reflect differences in trigger mechanisms or clinical outcomes is unclear. Here we examined differences in the clinical characteristics of typical and atypical forms of TCM. TCM patients (n = 251) in the BOREAS Registry were enrolled for comparison of TCM with apical ballooning (type A, n = 217) and TCM with non-apical ballooning (type non-A, n = 34). The percentage of females was significantly lower in the type non-A group (58.8 vs. 75.6 %), while other demographic parameters and triggers of TCM were similar in the two groups. Rate of mid-ventricular obstruction (MVO) was lower (2.9 vs. 14.3 %) in the type non-A group than in the type A group, though left ventricular ejection fractions in the two groups were comparable. During a follow-up period of 2.6 ± 2.8 years, TCM recurred in 2.9 % of the patients and cardiac death occurred in 4.0 %. Cox proportional hazard analysis indicated that body mass index (hazard ratio [HR]: 0.75, 95 % confidence interval [CI] 0.54–0.99) and MVO (HR: 14.71, CI 1.87–304.66) were determinants of TCM recurrence and that advanced age (HR: 1.09, CI 1.02–1.17) and cardiogenic shock (HR: 4.27, CI 1.07–18.93) were significantly associated with cardiac death. In conclusion, approximately 20 % of TCM patients show non-apical left ventricular ballooning, and female sex and MVO are less frequent in this type than in apical ballooning type TCM. Low body mass index and MVO are risk factors of recurrence, and advanced age and cardiogenic shock are risk factors of cardiac death in TCM.

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This study was supported by Sapporo Medical University Education and Research Grants. There is no relationship with industry and no conflict of interest in this study.

BOREAS-TCM investigators Junichi Nishida, Hidemichi Kouzu, Kazufumi Tsuchihashi, Takefumi Fujito, Mina Kawamukai, Atsushi Mochizuki, Atsuko Muranaka, Nobuaki Kokubu, Shinya Shimoshige, Satoshi Yuda, Mamoru Hase, Akiyoshi Hashimoto, Tetsuji Miura, Sapporo Medical University; Naoko Kobayashi, Gorinbashi Hospital; Hiroyuki Kita, Takayuki Fukuma, Satoshi Genda, Hakodate Goryoukaku Hospital; Daisuke Hotta, Hokkaido Cardiovascular Hospital; Atsushi Doi, Japanese Red Cross Asahikawa Hospital; Shuzaburo Fukuyama, Jikeikai Hospital; Hitomi Suzuki, Kin-ikyo Chuo Hospital; Norie Tanaka, Kushiro Koujinkai Memorial Hospital; Kimio Nishizato, Takuto Maeda, Muroran City General Hospital; Manabu Hayashi, Daigo Nagahara, Yasuyuki Shinshi, Yoshiaki Terashima, Obihiro Kosei General Hospital; Row Ishimoto, Jun Agata, Kazuyuki Naitoh, Yutaka Yokoyama, Obihiro Kyokai Hospital; Nobuhiro Yoshioka, Sapporo Cardiovascular Hospital; Noriyuki Fujii, Sapporo Social Insurance General Hospital; Takuji Yoshioka, Teine Keijinkai Hospital; Michifumi Kyuma, Tenshi Hospital.

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Correspondence to Tetsuji Miura.

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On behalf of BOREAS-TCM investigators.

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Nishida, J., Kouzu, H., Hashimoto, A. et al. “Ballooning” patterns in takotsubo cardiomyopathy reflect different clinical backgrounds and outcomes: a BOREAS-TCM study. Heart Vessels 30, 789–797 (2015).

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