Analysis of risk factors for stress cardiomyopathy after cardiac surgery

Stress cardiomyopathy (TTC) after open-heart surgery is rare but carries high morbidity. We aimed to identify independent perioperative risk factors.

This retrospective case-control study included 25 TTC patients and 100 time-selected controls from 4,872 consecutive Cardiopulmonary bypass (CPB) cases (January 2019-December 2023). Preoperative, intraoperative, and early postoperative variables were compared. Multivariate logistic regression was used to determine independent predictors.

Univariate analysis revealed significant differences in age, female sex, neuropsychiatric history, mitral/tricuspid surgery, CPB time, aortic cross-clamp time, and maximum epinephrine dose (all p < 0.05). Postoperative cardiogenic shock was a frequent consequence (84% vs. 7%). Multivariate analysis identified four independent risk factors: female sex (OR 4.67, 95% CI 1.52-14.32), mitral/tricuspid surgery (OR 8.93, 95% CI 2.89-27.58), CPB >180 min (OR 5.14, 95% CI 1.76-15.06), and intraoperative epinephrine >0.1 μg·kg^-1·min^-1 (OR 6.02, 95% CI 1.95-18.57; all p < 0.01).

Female sex, mitral/tricuspid surgery, prolonged CPB, and high-dose epinephrine are independent risk factors for postoperative TTC. Early echocardiographic surveillance, cautious catecholamine use, and right ventricular assessment may improve outcomes.