Takotsubo cardiomyopathy in the intensive care unit

An angiographic examination is necessary for the diagnosis of takotsubo cardiomyopathy (TTC). However, in the intensive care unit (ICU), intensivists often see patients in whom TTC cannot be diagnosed because they cannot undertake angiography due to the patient's poor general condition. We defined such cases as clinical TTC (cTTC) and investigated the incidence and background of cTTC in the ICU at Kansai Medical University Hospital (Osaka, Japan).

The study involved 5,084 patients who were admitted to the ICU of Kansai Medical University Hospital between January 2013 and December 2017. We retrospectively investigated the frequency and background of TTC and cTTC.

Of the 5,084 patients, 5 (0.09%) patients admitted to the ICU were diagnosed as having TTC and 19 patients (0.37%) were diagnosed as having cTTC. The most common primary disease among the evaluated patients was sepsis (n = 10) followed by subarachnoid hemorrhage (SAH) (n = 5). Ten of the 335 patients with sepsis (3.0%) were admitted to the ICU with complications due to cTTC. Their blood pressure and heart rate on admission tended to be high, and their Sequential Organ Failure Assessment scores tended to be low. Five of the 172 patients with SAH (2.9%) were admitted to the ICU with complications due to cTTC. These patients were often classified as grade 5 on the Hunt and Hess scale.

Our study suggests that patients with sepsis or SAH are complicated with cTTC in the ICU. In addition, there might be no correlation between the severity of sepsis and the development of TTC.