Incidence, clinical features and outcome of Takotsubo syndrome in the intensive care unit

Summary Background Most diseases encountered in the intensive care unit are associated with major stress that can potentially trigger Takotsubo syndrome. Many severe cardiovascular complications are associated with Takotsubo syndrome, yet little is known about Takotsubo syndrome in the intensive care unit. Aims We sought to determine the incidence of Takotsubo syndrome, and to describe its clinical features and outcome in an intensive care unit. Methods This prospective single-centre study included all patients admitted consecutively over a 12-month period who had transthoracic echocardiography, electrocardiography and a troponin I assay performed on admission, at 24 and 48 hours after admission, and at discharge and in the case of clinical worsening. Results The incidence of Takotsubo syndrome was 4.6% (13/280 patients) and female sex predominated (69.2%). The median age of the subgroup with Takotsubo syndrome was 64 (56–72) years. Pulmonary disease and sepsis were the most frequent triggers (46.2% and 38.5%, respectively). Median left ventricular ejection fraction was 29.0% (20.0–37.0). Patients with Takotsubo syndrome presented with shock and arrhythmias and needed ventilation more frequently than patients without Takotsubo syndrome (69.2% vs. 36.3%, P = 0.035; 46.2% vs. 13.5%, P = 0.006; and 92.3% vs. 60.7%, P = 0.021), but mortality rates were similar. The median delay to cardiac index recovery, when impaired, was 2.0 (1.0–2.75) days, and that of left ventricular ejection fraction was 12.5 (7–14.75) days. Conclusion Takotsubo syndrome in the intensive care unit is not uncommon and is associated with substantial haemodynamic and respiratory instability. New-onset arrhythmias and respiratory and haemodynamic worsening could arouse suspicion of and prompt screening for Takotsubo syndrome in the intensive care unit.