Usefulness of Malignancy as a Predictor of WorseIn-Hospital Outcomes in Patients With Takotsubo Cardiomyopathy

Abstract Introduction Takotsubo Cardiomyopathy (TCM) is characterized by reversible left ventricular dysfunction and predominantly affects post-menopausal women. However, it is rarely identified as a cause of acute heart failure in pregnancy. Objective We aimed to determine patient characteristics and in-hospital outcomes of TCM occurring in pregnancy. Methods We retrospectively analyzed the United States - National Inpatient Sample (NIS) Database from 2010–2014 to assess TCM in pregnant women ≥18 years using international classification of diseases 9th revision clinical modification (ICD-9-CM) codes. We compared patient demographics, co-morbidities and in-hospital outcomes between pregnant and non-pregnant women with TCM aged 18–49 years. Patients with a diagnosis of peripartum cardiomyopathy were excluded. Chi-square test and Student-t test or Mann- Whitney U test were used for categorical and continuous variables with normal and skewed distribution, respectively. Results TCM occurred at a younger age in pregnant women compared to non-pregnant women (Age [Mean ±SD]: 31.2±7.2 years vs. 41.8±7.1 years; p<0.001). Rates of TCM were higher during pregnancy in African American (19% vs. 11.5%; p=0.008), Hispanic (27.3% vs. 9.6%; p<0.001) and Asian women (11.3% vs. 2.6%; p<0.001) compared to non-pregnant women of similar race. However, among Caucasian women rates of TCM were higher in non-pregnant women (42.4% vs. 72.7%; p<0.001). There were no in-hospital deaths among pregnant women with TCM (0% vs. 5.2%; p=0.005), however they had higher rates of cardiogenic shock (13.8% vs. 5.8; p<0.001) and respiratory failure requiring mechanical ventilation (51.7% vs. 20.9%; p<0.001). The average length of hospitalization was also longer among pregnant women with TCM (Days [Mean±SD]: 5.8±4 vs. 5.5±7.5; p<0.001). Pregnant women had lower rates of diagnostic angiography (24.1% vs. 55.6%; p<0.001). Pregnant women with TCM had higher rates of ventricular fibrillation (6.9% vs. 2.9%; p=0.02), but had no atrial fibrillation (0% vs. 2.6%; p=0.05), atrial flutter (0% vs. 0.4%; p=0.43), paroxysmal supraventricular tachycardia (0% vs. 0.5%; p=0.4) and ventricular tachycardia (0% vs. 4.8%; p=0.07). Pregnant women with TCM had lower rates of psychiatric and certain medical co-morbidities: anxiety (6.9% vs. 20.4%; p<0.001), depression (0% vs. 2.6%; p=0.05), bipolar disorder (0% vs. 0.8%; p=0.3), hypertension (27.6% vs. 40.3%; p=0.002), hyperlipidemia (3.4% vs. 25.7%; p<0.001) and smoking (6.9% vs. 40.2%; p<0.001). The rates of diabetes (13.8% vs. 15.9%; p=0.5) and obesity (10.3% vs. 8.2%; p=0.37) were similar between the two groups. Conclusion There was no in-hospital mortality observed in pregnant women who developed TCM, however, they had increased rates of cardiogenic shock, mechanical ventilation, ventricular fibrillation and had longer hospitalizations. Funding Acknowledgement Type of funding source: None

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ETHNIC VARIATIONS IN PRESENTATION AND IN-HOSPITAL OUTCOMES OF TAKOTSUBO CARDIOMYOPATHY

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(19)31486-x ◽

2019 ◽

Vol 73 (9) ◽

pp. 879 ◽

Cited By ~ 1

Author(s):

Raja Zaghlol ◽

Kartikeya Kashyap ◽

Yazan Sawalha ◽

Ana Barac

Keyword(s):

Takotsubo Cardiomyopathy ◽

Hospital Outcomes ◽

Ethnic Variations

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The Impact of COPD on in-Hospital Outcomes in Patients with Takotsubo Cardiomyopathy

International Journal of Chronic Obstructive Pulmonary Disease ◽

10.2147/copd.s267289 ◽

2020 ◽

Vol Volume 15 ◽

pp. 2333-2341

Author(s):

Pengyang Li ◽

Xiaojia Lu ◽

Catherine Teng ◽

Peng Cai ◽

Mark Kranis ◽

...

Keyword(s):

Takotsubo Cardiomyopathy ◽

Hospital Outcomes ◽

The Impact

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B-PO02-160 IN HOSPITAL OUTCOMES OF TAKOTSUBO CARDIOMYOPATHY IN MEN COMPARED TO WOMEN IN THE US VETERAN AFFAIRS HEALTHCARE SYSTEM

Heart Rhythm ◽

10.1016/j.hrthm.2021.06.413 ◽

2021 ◽

Vol 18 (8) ◽

pp. S163

Author(s):

Bilal Alqam ◽

Fuad Habash ◽

Zaid Gheith ◽

Srikanth Vallurupalli ◽

Waddah Maskoun

Keyword(s):

Healthcare System ◽

Takotsubo Cardiomyopathy ◽

Hospital Outcomes ◽

Veteran Affairs ◽

The Us

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The Association Between Hyperlipidemia and In-Hospital Outcomes in Takotsubo Cardiomyopathy

Diabetes Metabolic Syndrome and Obesity Targets and Therapy ◽

10.2147/dmso.s282009 ◽

2021 ◽

Vol Volume 14 ◽

pp. 117-126

Author(s):

Pengyang Li ◽

Xiaojia Lu ◽

Catherine Teng ◽

Michelle Hadley ◽

Peng Cai ◽

...

Keyword(s):

Takotsubo Cardiomyopathy ◽

Hospital Outcomes

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2373Effect of ethninicty on in-hospital outcomes of takotsubo cardiomyopathy, data from the national inpatient sample database

European Heart Journal ◽

10.1093/eurheartj/ehz748.0140 ◽

2019 ◽

Vol 40 (Supplement_1) ◽

Author(s):

R Zaghlol ◽

S Desale ◽

A Barac

Keyword(s):

African Americans ◽

Takotsubo Cardiomyopathy ◽

Hospital Admissions ◽

Invasive Mechanical Ventilation ◽

University Hospital ◽

P Value ◽

National Inpatient Sample ◽

Hospital Outcomes ◽

Weighted Estimates ◽

Baseline Characteristics

Abstract Background The effect of ethnicity on in-hospital outcomes of takotsubo cardiomyopathy (TC) is unknown. Purpose To investigate ethnic variations in hospital outcomes of TC in a large nationwide sample. Methods The National Inpatient Sample (NIS) database was searched from 2004 to 2014 for the ICD-9-CM code 429.83 to obtain weighted estimates of TC hospitalizations. Based on self-reported ethnicity, African-Americans (AA) and Hispanics were compared to Caucasians for differences in baseline characteristics and in-hospital outcomes. Multivariate regression models were used to adjust for potential confounders. Results Of 103891 hospital admissions identified, 89624 (86.3%) were Caucasians, 8026 (7.7%) were AA and 6241 (6%) were Hispanics. Caucasians were older with more females as compared to AA and Hispanics (67.5 [0.13] vs 61.8 [0.45] vs 63.2 [0.52] years, p<0.0001) and (78135 [87.2%] vs 6672 [83.1%] vs 5196 [83.3%], p<0.0001) respectively. Patients' demographics and baseline characteristics are shown in table 1. In unadjusted analysis (Figure 1), compared to Caucasians, AA had more cardiac arrests (304 [3.79%] vs 2569 [2.87%], p=0.038), invasive mechanical ventilation (1671 [20.8%] vs 15897 [17.7%], p<0.002) and tracheostomies (242 [3%] vs 1600 [1.8%], p=0.0009). When comparing Hispanics to Caucasians, Hispanics had higher mortality (426 [6.83%] vs 4573 [5.1] deaths, p=0.007). In adjusted analysis for baseline characteristics differences and hospital location/teaching status, AA had less cardiogenic shocks (OR=0.71 [95% CI 0.56–0.91], p=0.006) and intraaortic balloon pump support (OR= 0.6 [95% CI 0.39- 0.93], p=0.023) but required longer hospitalization (1.64 vs 1.56 log transformed-days, p=0.0001) as compared to Caucasians. Hispanics still had higher mortality than Caucasians (OR =1.27 [95% CI 1.01–1.61], p=0.04). Table 1. Patients' demographics and baseline characteristics Parameter Caucasians African Americans Hispanics Total p-value Age, years 67.46 (0.13) 61.77 (0.45) 63.15 (0.52) 66.76 (0.12) <0.0001 Females 78,135 (87.18%) 6,672 (83.13%) 5,196 (83.25%) 90,003 (86.63%) <0.0001 Congestive heart failure 20,693 (23.09%) 2,066 (25.73%) 1,395 (22.36%) 24,155 (23.25%) 0.055 Chronic lung disease 26,815 (29.92%) 1,971 (24.54%) 1,200 (19.22%) 29,986 (28.86%) <0.0001 Diabetes mellitus 15,295 (17.07%) 2,071 (25.79%) 1,711 (27.41%) 19,077 (18.36%) <0.0001 Chronic kidney disease 9,065 (10.11%) 1,315 (16.37%) 795 (12.74%) 11,174 (10.76%) <0.0001 Smoking 29,535 (32.95%) 2,660 (33.13%) 1,303 (20.87%) 33,498 (32.24%) <0.0001 Figure 1. In-Hospital Outcomes Conclusion There is ethnic variation in hospital outcomes of takotsubo cardiomyopathy, some of which may be related to differences in patients' demographics and baseline characteristics. Acknowledgement/Funding Medstar Georgetown University Hospital/ Washington Hospital Center graduate medical education department funded the purchase of the database

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Abstract 14875: Chronic Obstructive Pulmonary Disease Negatively Affects In-hospital Outcomes in Patients With Takotsubo Cardiomyopathy

Circulation ◽

10.1161/circ.142.suppl_3.14875 ◽

2020 ◽

Vol 142 (Suppl_3) ◽

Author(s):

Pengyang Li ◽

Catherine Teng ◽

Mark Kranis ◽

Peng Cai ◽

Qiying Dai ◽

...

Keyword(s):

Chronic Obstructive Pulmonary Disease ◽

Propensity Score ◽

Cardiogenic Shock ◽

Takotsubo Cardiomyopathy ◽

Primary Diagnosis ◽

Chronic Obstructive ◽

Inpatient Mortality ◽

Hospital Outcomes ◽

Obstructive Pulmonary Disease ◽

Hospitalization Costs

Introduction: Chronic obstructive pulmonary disease (COPD) is a known comorbidity of takotsubo cardiomyopathy (TCM), and COPD exacerbation is a potential trigger of TCM. The association between COPD and in-hospital outcomes and complications in TCM patients is not well established. Aim: We aimed to assess the effect of COPD on hospitalized patients with a primary diagnosis of TCM. Methods: Using the latest National Inpatient Sample from 2016-2017, we conducted a retrospective cohort study in patients with a primary diagnosis of TCM with or without COPD. The diagnosis was identified by the ICD-10-CM coding system. We identified 3,139 patients admitted with a primary diagnosis of TCM; 684 of those patients also had a diagnosis of COPD. We performed propensity score matching in a 1:2 ratio (n=678 patients, matched COPD group; n=1,070, matched non-COPD group) and compared in-hospital outcomes and complications between TCM patients with and without a COPD diagnosis. Results: Before matching, the COPD group had worse outcomes compared with the non-COPD group in inpatient death (2.9% vs. 1.3%, p=0.006), length of stay (LOS) (4.02±2.99 days vs. 3.27±3.39 days, p<0.001), hospitalization costs ($55,242.68±47,637.40 vs. $48,316.97±47,939.84, p=0.001), and acute respiratory failure (ARF) (22.5% vs. 7.7%, p<0.001), respectively. After propensity score matching, the matched COPD group, compared with the matched non-COPD group, had a higher inpatient mortality rate (2.9% vs.1.0%, p=0.005), longer LOS (4.02±3.00 days vs. 3.40±3.54 days, p<0.001), higher hospitalization costs ($55,409.23±47,809.13 vs. $44,6469.60±42,209.10, p<0.001), and a higher incidence of ARF (22.6% vs. 8.2%, p<0.001) and cardiogenic shock (5.6% vs. 3.3%, p=0.024), respectively. Conclusions: Patients who are hospitalized for TCM and have COPD have higher rates of inpatient mortality, ARF, and cardiogenic shock, as well as a longer LOS and a higher cost of stay than TCM patients without COPD. Prospective studies are warranted to examine the effect of early intervention or treatment of COPD on short and long-term outcomes of TCM.

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