Neurocritical Care

, Volume 30, Issue 1, pp 171–176 | Cite as

The Risk of Takotsubo Cardiomyopathy in Acute Neurological Disease

  • Nicholas A. Morris
  • Abhinaba Chatterjee
  • Oluwayemisi L. Adejumo
  • Monica Chen
  • Alexander E. Merkler
  • Santosh B. Murthy
  • Hooman KamelEmail author
Original Article



Case series have reported reversible left ventricular dysfunction, also known as stress cardiomyopathy or Takotsubo cardiomyopathy (TCM), in the setting of acute neurological diseases such as subarachnoid hemorrhage. The relative associations between various neurological diseases and Takotsubo remain incompletely understood.


We performed a cross-sectional study of all adults in the National Inpatient Sample, a nationally representative sample of US hospitalizations, from 2006 to 2014. Our exposures of interest were primary diagnoses of acute neurological disease, defined by ICD-9-CM diagnosis codes. Our outcome was a diagnosis of TCM. Binary logistic regression models were used to examine the associations between our pre-specified neurological diagnoses and TCM after adjustment for demographics.


Among acute neurological diagnoses, the strongest associations were seen with subarachnoid hemorrhage (odds ratio [OR] 11.7; 95% confidence interval [CI] 10.2–13.4), status epilepticus (OR 4.9; 95% CI 3.7–6.3), and seizures (OR 1.3; 95% CI 1.1–1.5). In a sensitivity analysis including secondary diagnoses of acute neurological diagnoses, associations were also seen with transient global amnesia (OR 2.3; 95% CI 1.5–3.6), meningoencephalitis (OR 2.1; 95% CI 1.7–2.5), migraine (OR 1.7; 95% CI 1.5–1.8), intracerebral hemorrhage (OR 1.3; 95% CI 1.1–1.5), and ischemic stroke (OR 1.2; 95% CI 1.1–1.3). In addition, female sex was strongly associated with Takotsubo (OR 5.1; 95% CI 4.9–5.4).


TCM appears to be associated with varying degrees with several acute neurological diseases besides subarachnoid hemorrhage.


Cardiomyopathies Ventricular dysfunction Takotsubo cardiomyopathy Nervous system diseases Critical care Subarachnoid hemorrhage Status epilepticus 


Author Contribution

NAM conceived and designed the study, interpreted the data, drafted the article and revised it for important intellectual content, and gave final approval of the version to be published. AC acquired, analyzed, and interpreted the data, revised the article for important intellectual content, and gave final approval of the version to be published. OLA acquired the data, revised the article critically for important intellectual content, and gave final approval of the version to be published. MC acquired and analyzed the data, revised the article critically for important intellectual content, and gave final approval of the version to be published. AEM conceived and designed the study, interpreted the data, revised the article for important intellectual content, and gave final approval of the version to be published. SBM conceived and designed the study, interpreted the data, revised the article for important intellectual content, and gave final approval of the version to be published. HK conceived and designed the study, interpreted the data, revised the article for important intellectual content, and gave final approval of the version to be published.

Source of Support

Financial support for this study was provided by Grant K23NS082367 (Dr. Kamel) from the National Institute of Neurological Disorders and Stroke and a grant from the Michael Goldberg Stroke Research Fund (Dr. Kamel).

Compliance with Ethical Standards

Conflict of interest

The authors have no conflicts of interest to report.


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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature and Neurocritical Care Society 2018

Authors and Affiliations

  • Nicholas A. Morris
    • 1
  • Abhinaba Chatterjee
    • 2
  • Oluwayemisi L. Adejumo
    • 3
  • Monica Chen
    • 2
  • Alexander E. Merkler
    • 2
    • 4
  • Santosh B. Murthy
    • 2
    • 4
  • Hooman Kamel
    • 2
    • 4
    Email author
  1. 1.Department of Neurology, Program in TraumaUniversity of Maryland School of MedicineBaltimoreUSA
  2. 2.Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research InstituteWeill Cornell Medical CollegeNew YorkUSA
  3. 3.Division of CardiologyWeill Cornell Medical CollegeNew YorkUSA
  4. 4.Department of NeurologyWeill Cornell Medical CollegeNew YorkUSA

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