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Predictive factors for recovery of left ventricular systolic function in stress cardiomyopathy
1Fukuyama Medical Center - Fukuyama - Japan
Introduction Stress cardiomyopathy is a reversible systolic dysfunction of the left ventricle that is characterized by defined wall motion abnormalities in the absence of significant coronary stenosis. It is prevalent among elderly women, and often arises following a physical or emotionally stressful event. Little is known about the prognostic factors affecting the recovery of systolic function. Objective The present study aimed to identify factors affecting the recovery of left ventricular systolic function. Materials and Methods This retrospective review analyzed the electronic medical records of 41 patients diagnosed with stress cardiomyopathy at our Medical Centre between April 2008 and March 2018. Results The median time to the recovery of ejection fraction (EF) was 7.0 days. Demographic and clinical factors were compared between groups with early recovery (= 7 days; group E) and late recovery (> 8 days; group L). Age (75.5 ± 10.7 vs. 73.9 ± 14.6 years), physical stress (89.1% vs. 72.3%), emotional stress (10.6% vs. 27.3%) and in-hospital death (15.8% vs. 9.1%) did not differ significantly between the L and the E groups, respectively. Heart rate and the prevalence of Killip class > 2 heart failure upon admission was higher in the L, than the E group (101.1 ± 24.4 vs. 86.2 ± 24.2 bpm, p < 0.05 and 13% vs. 6%, p < 0.01), respectively. Echocardiography revealed significantly lower left ventricular ejection fraction in the L, than the E group (38.4 ± 7.0% vs. 49.6 ± 13.0% p < 0.001). Laboratory findings showed significantly higher C reactive protein (7.67 ± 6.49 vs. 4.90 ± 8.97 mg/dL, p < 0.05) and creatinine phosphokinase (556.1 ± 864.3 vs. 127.3 ± 162.2 IU/L, p < 0.01) and significantly lower hemoglobin (10.27 ± 2.23 vs. 11.51 ± 1.95 g/dL, p < 0.05) and LDL-cholesterol (80.5 ± 26.9 vs. 111.9 ± 41.6 mg/dL, p < 0.05) in the L, than in the E group. Significantly more patients were medicated with warfarin/Directly acting oral anticoagulants (DOACs) (42.1% vs. 18.2%), ß-blockers (47.4% vs. 31.8%), catecholamine (42.1% vs. 13.6%) and required non-invasive positive pressure ventilation (NIPPV)(26.3% vs. 0.0%) in the L, than the E group (p < 0.05 for all). Conclusion Severe cardiac dysfunction at onset and triggering septic or inflammatory disease were seen more commonly in the L group. Although more patients in the L group required warfarin/DOAC, ß-blockers, catecholamine and even NIPPV more often than the E group, the prognosis was fairly good for both groups with stress cardiomyopathy.
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