Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy

J Am Coll Cardiol. 2010 Jan 26;55(4):333-41. doi: 10.1016/j.jacc.2009.08.057.


Objectives: This study was designed to define more completely the clinical spectrum and consequences of stress cardiomyopathy (SC) beyond the acute event.

Background: Stress cardiomyopathy is a recently recognized condition characterized by transient cardiac dysfunction with ventricular ballooning.

Methods: Clinical profile and outcome were prospectively assessed in 136 consecutive SC patients.

Results: Patients were predominantly women (n = 130; 96%), but 6 were men (4%). Ages were 32 to 94 years (mean age 68 +/- 13 years); 13 (10%) were <or=50 years of age. In 121 patients (89%), SC was precipitated by intensely stressful emotional (n = 64) or physical (n = 57) events, including 22 associated with sympathomimetic drugs or medical/surgical procedures; 15 other patients (11%) had no evident stress trigger. Twenty-five patients (18%) were taking beta-blockers at the time of SC events. Three diverse ventricular contraction patterns were defined by cardiovascular magnetic resonance (CMR) imaging, usually with rapid return to normal systolic function, although delayed >2 months in 5%. Right and/or left ventricular thrombi were identified in 5 patients (predominantly by CMR imaging), including 2 with embolic events. Three patients (2%) died in-hospital and 116 (85%) have survived, including 5% with nonfatal recurrent SC events. All-cause mortality during follow-up exceeded a matched general population (p = 0.016) with most deaths occurring in the first year.

Conclusions: In this large SC cohort, the clinical spectrum was heterogeneous with about one-third either male, <or=50 years of age, without a stress trigger, or with in-hospital death, nonfatal recurrence, embolic stroke, or delayed normalization of ejection fraction. Beta-blocking drugs were not absolutely protective and SC was a marker for increased noncardiac mortality. These data support expanded management and surveillance strategies including CMR imaging and consideration for anticoagulation.

Publication types

  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adrenergic beta-Antagonists / adverse effects
  • Adult
  • Aged
  • Aged, 80 and over
  • Biomarkers / blood
  • Electrocardiography
  • Female
  • Heart Failure / etiology
  • Humans
  • Magnetic Resonance Imaging
  • Male
  • Middle Aged
  • Stress, Psychological
  • Takotsubo Cardiomyopathy / complications
  • Takotsubo Cardiomyopathy / etiology
  • Takotsubo Cardiomyopathy / mortality
  • Takotsubo Cardiomyopathy / physiopathology*
  • Takotsubo Cardiomyopathy / therapy
  • Troponin / blood
  • Ventricular Function


  • Adrenergic beta-Antagonists
  • Biomarkers
  • Troponin