Coronary artery disease
Frequency of Takotsubo Cardiomyopathy in Postmenopausal Women Presenting With an Acute Coronary Syndrome

https://doi.org/10.1016/j.amjcard.2013.04.010Get rights and content

Takotsubo cardiomyopathy (TC) may be more common than previously reported in postmenopausal women (PMW) presenting with acute coronary syndrome (ACS). TC often masquerades as an ACS with electrocardiographic changes, elevated troponins, and/or chest discomfort. Its exact incidence in ACS is unknown but most studies suggest it is 1% to 2.2%. As most patients with TC are PMW, it was hypothesized that the incidence would be greater in this population. A prospective evaluation was carried out in all middle-aged and older women (≥45 years of age) presumed to be peri- or postmenopausal with an elevated troponin presenting to a community hospital over a 1-year period (July 2011 to July 2012). Troponin results above the upper limit of normal were screened on a daily basis through a computerized system. The patients' in-hospital charts were reviewed and determined if they fulfilled the criteria for acute myocardial infarction according to the universal definition of myocardial infarction. Prespecified criteria were used to identify all patients with TC. Of the 1,297 PMW screened for positive troponins, 323 patients (24.9%) fulfilled the criteria for acute myocardial infarction and of these, 19 (5.9%) met the prespecified criteria for TC. Three additional patients with TC had acute neurologic events. Most patients (81.8%) had the apical variant. In conclusion, TC may be more common than reported in PMW with clinical and laboratory criteria suggesting acute myocardial infarction. Heightened awareness of TC in this population appears warranted.

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Methods

The study cohort consisted of all middle-aged and older women (≥45 years of age) presumed to be peri- or postmenopausal with positive troponin-I cardiac biomarker (Siemens Centaur Assay, Siemens, Tarrytown, New York; Sensitivity >0.006 ng/ml, positive >0.04 ng/ml) who required inpatient treatment for any medical condition at a regional community hospital with Level 1 Trauma certification (Fresno, California) from July 21, 2011 to July 20, 2012. The decision to admit the patient was made by the

Results

There were 1,297 patients with positive troponin-I biomarkers (Siemens Centaur Assay; positive >0.04 ng/ml). Most of these patients (75.1%; n = 974) did not meet criteria for ACS whereas the remaining 24.9% (n = 323) fulfilled an ACS diagnosis (see Figure 2).

Overall, there were 22 patients who fulfilled the criteria for TC (see Table 1). The average age of all patients with TC was 64.7 ± 11.5 years. The peak troponin was 5.9 ± 10.8 ng/ml and average ejection fraction during the episode was 34 ±

Discussion

This study demonstrates an incidence of 5.9% for TC over a 1-year period in PMW admitted with a suspected ACS. Using these prespecified, expanded criteria for TC, the incidence in these women is greater than that reported in a recent study in all patients with ACS5 and in an international registry.10 As this study focused only on middle-aged and older women and used a broader definition than that used in other studies, the approximate threefold greater incidence from the present investigation

Disclosures

The authors have no conflicts of interest to disclose.

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