Outcomes of Takotsubo cardiomyopathy in hospitalized cancer patients
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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.
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.
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).
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.
KeywordsStress cardiomyopathy Cancer Outcomes Mortality
Compliance with ethical standards
Conflict of interest
The authors declare that they have no competing interest.
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.
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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
- 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