Background
Stress-induced cardiomyopathy (SIC) is a novel syndrome increasingly recognized worldwide. Because the clinical presentation of SIC is very similar to acute coronary syndromes, the diagnosis is most frequently made by the interventional cardiologist in the catheterization laboratory. However, the epidemiology, optimal treatment, prognosis, and pathophysiology are not sufficiently studied. In this study, we present the results after a long-term follow-up of one of the largest SIC cohorts to date.
Results
One hundred ten consecutive SIC patients were registered between January 2005 and January 2010. 13.6% were males and 86.4% females, age range 17–91 years. Thirty-day and 1-year mortality rates were 5.5% and 10.9%, respectively. Twelve patients (10.9%) had one or more significant coronary artery stenoses on angiogram. 86.3% of patients presented with large akinetic areas in the apical segments of the left ventricle. In 12.7%, other pattern of reversible regional akinesia was present. In one male patient, SIC was induced by habitual angina pectoris. Five percent developed thromboembolic complications (lung, brain, and kidney) and 3% developed cardiac arrest. Only 5% of patients were “non-Swedish,” although 28% of all inhabitants in the Gothenburg area are of non-Swedish origin. In four families, several closest relatives developed SIC (mother and son, mother and daughter, sisters and brothers). 11.8% developed two or more episodes of SIC. Hemodynamic evaluation in clinically stable patients has shown subnormal systemic vascular resistance (SVR) and preserved cardiac output. Sympathetic nerve activity (SNA) (microneurography) to the muscle vascular bed was subnormal in SIC compared to the healthy controls. Patients exposed to inotropic treatment have shown prolonged recovery period. 13.6% have developed cardiogenic shock (CS). Treatment with intra-aortic counter-pulsation pump deteriorated hemodynamic status in patients with CS in the presence of significant intracavitar gradient due to the hyper-contractile basal segments. Autopsy studies have shown intracellular lipid accumulation in the hearts. All surviving patients recovered to normal cardiac function.
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