Advertisement

Journal of Cancer Research and Clinical Oncology

, Volume 144, Issue 8, pp 1539–1545 | Cite as

Outcomes of Takotsubo cardiomyopathy in hospitalized cancer patients

  • Parijat Saurav Joy
  • Achuta Kumar Guddati
  • Iuliana Shapira
Original Article – Clinical Oncology
  • 84 Downloads

Abstract

Background

Chemotherapy-induced cardiomyopathy is a critical complication of treatment for cancer. The emotional stress of a cancer diagnosis, ongoing chemotherapy, abnormal cancer-related wasting syndrome may contribute to cardiac morbidity in these patients. The burden of Takotsubo Cardiomyopathy (TCM) in cancer patients is unknown. The incidence of TCM and related outcomes in cancer patients was investigated in this study.

Methods

The 2007–2013 National Inpatient Sample (NIS) was analyzed for patients with a prior and new diagnosis of TCM with and without malignancy. Risk factors for mortality were adjusted for associated conditions by multivariable logistic regression analysis.

Results

From 2007 to 2013, an estimated 122,855 adults were admitted with a diagnosis of TCM. In 2013, the incidence of admissions in US of patients with coexisting TCM and malignancy was 1.13%. Patients admitted for TCM with coexisting malignancy had a significantly higher mortality (13.8 vs. 2.9%, p < 0.0001), length of stay (7 vs. 4 days, p < 0.0001) and total charges ($29,291 vs. $36,231, p < 0.0001), compared to those with no malignancy. In patients with a primary diagnosis of TCM and without any underlying malignancy, males had a higher mortality (4.02 vs. 1.03%, p < 0.0001), whereas there was no gender difference in mortality in those with coexisting malignancy (6.25 vs. 6.45%, p = 0.965). On multivariable logistic regression analysis, risk factors associated with mortality were solid cancer (OR 3.43, p = 0.008), stroke (OR 18.33, p < 0.0001) and heart failure (OR 1.918, p = 0.004).

Conclusions

Outcomes are significantly worse in patients with TCM and malignancy. Hence, this patient population must be regarded as high-risk and early diagnostic consideration for TCM is warranted. Early intervention may help lower mortality, decrease resource utilization and reduce the health care costs in these patients.

Keywords

Stress cardiomyopathy Cancer Outcomes Mortality 

Notes

Funding

None.

Compliance with ethical standards

Conflict of interest

The authors declare that they have no competing interest.

Ethical approval

This is a retrospective study based on a publicly available database of the US government which uses de-identified patient data. This article does not contain any studies with human participants or animals performed by any of the authors.

Supplementary material

432_2018_2661_MOESM1_ESM.docx (15 kb)
Supplementary material 1 (DOCX 15 KB)
432_2018_2661_MOESM2_ESM.docx (15 kb)
Supplementary material 2 (DOCX 16 KB)
432_2018_2661_MOESM3_ESM.docx (14 kb)
Supplementary material 3 (DOCX 14 KB)

References

  1. Baumann S, Huseynov A, Goranova D, Faust M, Behnes M, Nolte F et al (2014) Takotsubo cardiomyopathy after systemic consolidation therapy with high-dose intravenous cytarabine in a patient with acute myeloid leukemia. Oncol Res Treat 37(9):487–490.  https://doi.org/10.1159/000365536 CrossRefPubMedGoogle Scholar
  2. Burgdorf C, Kurowski V, Bonnemeier H, Schunkert H, Radke PW (2008) Long-term prognosis of the transient left ventricular dysfunction syndrome (Tako-Tsubo cardiomyopathy): focus on malignancies. Eur J Heart Fail 10(10):1015–1019.  https://doi.org/10.1016/j.ejheart.2008.07.008 CrossRefPubMedGoogle Scholar
  3. Burgdorf C, Nef HM, Haghi D, Kurowski V, Radke PW (2010) Tako-tsubo (stress-induced) cardiomyopathy and cancer. Ann Intern Med 152(12):830–831.  https://doi.org/10.7326/0003-4819-152-12-201006150-00026 CrossRefPubMedGoogle Scholar
  4. De Pasquale MD, Mastronuzzi A, De Sio L, Serra A, Grimaldi C, Chinali M et al (2016) Transient global ventricular dysfunction in an adolescent affected by pancreatic adenocarcinoma. BMC Pediatr 16:99.  https://doi.org/10.1186/s12887-016-0628-4 CrossRefPubMedPubMedCentralGoogle Scholar
  5. Dote K, Sato H, Tateishi H, Uchida T, Ishihara M (1991) Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases. J Cardiol 21(2):203–14PubMedGoogle Scholar
  6. Gangadhar TC, Von der Lohe E, Sawada SG, Helft PR (2008) Takotsubo cardiomyopathy in a patient with esophageal cancer: a case report. J Med Case Rep 2:379.  https://doi.org/10.1186/1752-1947-2-379 CrossRefPubMedPubMedCentralGoogle Scholar
  7. Girardey M, Jesel L, Campia U, Messas N, Hess S, Imperiale A et al (2016) Impact of malignancies in the early and late time course of Takotsubo cardiomyopathy. Circ J 80(10):2192–2198.  https://doi.org/10.1253/circj.CJ-16-0388 CrossRefPubMedGoogle Scholar
  8. Hammer N, Kuhne C, Meixensberger J, Hansel B, Winkler D (2015) Takotsubo cardiomyopathy—an unexpected complication in spine surgery. Int J Surg Case Rep 6C:172–174.  https://doi.org/10.1016/j.ijscr.2014.10.002 CrossRefPubMedGoogle Scholar
  9. Joo I, Lee JM, Han JK, Choi BI, Park EA (2011) Stress (tako-tsubo) cardiomyopathy following radiofrequency ablation of a liver tumor: a case report. Cardiovasc Interv Radiol 34(Suppl 2):S86-9.  https://doi.org/10.1007/s00270-010-9805-2 CrossRefGoogle Scholar
  10. Joy PS, Kumar G (2015) Delirium tremens is a risk factor for Takotsubo cardiomyopathy. Int J Cardiol 191:185–186.  https://doi.org/10.1016/j.ijcard.2015.04.251 CrossRefPubMedGoogle Scholar
  11. Kepez A, Yesildag O, Erdogan O, Aktas B (2012) Takotsubo cardiomyopathy in a patient with lung adenocarcinoma. Heart Views Off J Gulf Heart Assoc 13(3):107–10.  https://doi.org/10.4103/1995-705X.102154 CrossRefGoogle Scholar
  12. Koo N, Yoon BW, Song Y, Lee CK, Lee TY, Hong JY (2015) Biventricular Takotsubo cardiomyopathy associated with epilepsy. J Cardiovasc Ultrasound 23(4):262–265.  https://doi.org/10.4250/jcu.2015.23.4.262 CrossRefPubMedPubMedCentralGoogle Scholar
  13. Kumar G, Holmes DR Jr, Prasad A (2010) “Familial” apical ballooning syndrome (Takotsubo cardiomyopathy). Int J Cardiol 144(3):444–445.  https://doi.org/10.1016/j.ijcard.2009.03.078 CrossRefPubMedGoogle Scholar
  14. Kurowski V, Kaiser A, von Hof K, Killermann DP, Mayer B, Hartmann F et al (2007) Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis. Chest 132(3):809–816.  https://doi.org/10.1378/chest.07-0608 CrossRefPubMedGoogle Scholar
  15. Ladha KS, Zhao K, Quraishi SA, Kurth T, Eikermann M, Kaafarani HM et al (2015) The Deyo-Charlson and Elixhauser-van Walraven Comorbidity Indices as predictors of mortality in critically ill patients. BMJ Open 5(9):e008990.  https://doi.org/10.1136/bmjopen-2015-008990 CrossRefPubMedPubMedCentralGoogle Scholar
  16. Lopez Chiriboga AS, Yoon JW, Freeman WD, Odunukan OW, Cheshire WP Jr (2016) Takotsubo cardiomyopathy in the setting of acute hydrocephalus secondary to neurocysticercosis. Clin Auton Res Off J Clin Auton Res Soc 26(3):235–241.  https://doi.org/10.1007/s10286-016-0348-8 CrossRefGoogle Scholar
  17. Madias JE (2016) Is the specific effect of receiving oxaliplatin, or merely the nonspecific effect of having suffered cancer, the cause of Takotsubo syndrome? J Cardiovasc Med 17(1):69.  https://doi.org/10.2459/JCM.0000000000000247 CrossRefGoogle Scholar
  18. Malley T, Watson E (2016) A case of Takotsubo cardiomyopathy after chemotherapy. Oxf Med Case Rep 2016(4):55–58.  https://doi.org/10.1093/omcr/omw014 CrossRefGoogle Scholar
  19. Modi S, Baig W (2009) Radiotherapy-induced Tako-tsubo cardiomyopathy. Clin Oncol (R Coll Radiol) 21(4):361–362.  https://doi.org/10.1016/j.clon.2009.01.005 CrossRefGoogle Scholar
  20. Munoz E, Iliescu G, Vejpongsa P, Charitakis K, Karimzad K, Lopez-Mattei J et al (2016) Takotsubo stress cardiomyopathy: “good news” in cancer patients? J Am Coll Cardiol 68(10):1143–1144.  https://doi.org/10.1016/j.jacc.2016.06.027 CrossRefPubMedGoogle Scholar
  21. Ng KH, Dearden C, Gruber P (2015) Rituximab-induced Takotsubo syndrome: more cardiotoxic than it appears? BMJ Case Rep.  https://doi.org/10.1136/bcr-2014-208203 CrossRefPubMedPubMedCentralGoogle Scholar
  22. Numico G, Sicuro M, Silvestris N, Mozzicafreddo A, Trogu A, Malossi A et al (2012) Takotsubo syndrome in a patient treated with sunitinib for renal cancer. J Clin Oncol 30(24):e218–e220.  https://doi.org/10.1200/JCO.2012.42.4911 CrossRefPubMedGoogle Scholar
  23. Ovadia D, Esquenazi Y, Bucay M, Bachier CR (2015) Association between takotsubo cardiomyopathy and axitinib: case report and review of the literature. J Clin Oncol 33(1):e1–e3.  https://doi.org/10.1200/JCO.2013.48.7280 CrossRefPubMedGoogle Scholar
  24. Po-Yen H, Po-Ming K (2017) Takotsubo cardiomyopathy in a patient with undiscovered sigmoid colon cancer. Case Rep Cardiol 2017:4563203.  https://doi.org/10.1155/2017/4563203 PubMedPubMedCentralCrossRefGoogle Scholar
  25. Qasem A, Bin Abdulhak AA, Aly A, Moormeier J (2016) Capecitabine-induced takotsubo cardiomyopathy: a case report and literature review. Am J Ther 23(5):e1188–e1192.  https://doi.org/10.1097/MJT.0000000000000134 CrossRefPubMedGoogle Scholar
  26. Saif MW, Smith M, Maloney A (2016) The first case of severe takotsubo cardiomyopathy associated with 5-fluorouracil in a patient with abnormalities of both dihydropyrimidine dehydrogenase (DPYD) and thymidylate synthase (TYMS) genes. Cureus 8(9):e783.  https://doi.org/10.7759/cureus.783 PubMedPubMedCentralCrossRefGoogle Scholar
  27. Sattler K, El-Battrawy I, Lang S, Zhou X, Schramm K, Tulumen E et al (2017) Prevalence of cancer in Takotsubo cardiomyopathy: short and long-term outcome. Int J Cardiol.  https://doi.org/10.1016/j.ijcard.2017.02.093 CrossRefPubMedGoogle Scholar
  28. Scantlebury DC, Prasad A (2014) Diagnosis of Takotsubo cardiomyopathy. Circ J 78(9):2129–2139CrossRefPubMedGoogle Scholar
  29. Singh SB, Harle IA (2014) Takotsubo cardiomyopathy secondary in part to cancer-related pain crisis: a case report. J Pain Symptom Manag 48(1):137–142.  https://doi.org/10.1016/j.jpainsymman.2013.09.002 CrossRefGoogle Scholar
  30. Smith SA, Auseon AJ (2013) Chemotherapy-induced takotsubo cardiomyopathy. Heart Fail Clin 9(2):233–242, x.  https://doi.org/10.1016/j.hfc.2012.12.009
  31. Summers MR, Lennon RJ, Prasad A (2010) Pre-morbid psychiatric and cardiovascular diseases in apical ballooning syndrome (tako-tsubo/stress-induced cardiomyopathy): potential pre-disposing factors? J Am Coll Cardiol 55(7):700–701.  https://doi.org/10.1016/j.jacc.2009.10.031 CrossRefPubMedGoogle Scholar
  32. Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M et al (2015) Clinical features and outcomes of takotsubo (stress) cardiomyopathy. N Engl J Med 373(10):929–938.  https://doi.org/10.1056/NEJMoa1406761 CrossRefPubMedGoogle Scholar
  33. Toyooka S, Akagi S, Furukawa M, Nakamura K, Soh J, Yamane M et al (2012) Takotsubo cardiomyopathy associated with pulmonary resections after induction chemoradiotherapy for non-small cell lung cancer. Gen Thorac Cardiovas Surg 60(9):599–602.  https://doi.org/10.1007/s11748-012-0058-7 CrossRefGoogle Scholar
  34. Wittstein IS, Thiemann DR, Lima JA, Baughman KL, Schulman SP, Gerstenblith G et al (2005) Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 352(6):539–548.  https://doi.org/10.1056/NEJMoa043046 CrossRefPubMedGoogle Scholar

Copyright information

© Springer-Verlag GmbH Germany, part of Springer Nature 2018

Authors and Affiliations

  • Parijat Saurav Joy
    • 1
  • Achuta Kumar Guddati
    • 2
  • Iuliana Shapira
    • 3
  1. 1.Department of Internal MedicineUniversity of Iowa Hospitals and ClinicsIowa CityUSA
  2. 2.Division of Hematology/OncologyTulane UniversityNew OrleansUSA
  3. 3.Division of Hematology/OncologySUNY Downstate Medical CenterBrooklynUSA

Personalised recommendations