Characterising the Clinical Spectrum, Diagnosis and Outcomes in Secondary Stress Cardiomyopathy.

Introduction: Available literature on takotsubo cardiomyopathy excludes critically ill patients due to challenges in angiographic confirmation. Secondary stress cardiomyopathy (sSC) occurs in patients already hospitalised for other critical illnesses. Diagnosis of sSC is challenging, while clinical presentation and outcomes are significantly different from primary stress cardiomyopathy. Our aim was to better characterise the clinical picture of sSC.

Methods: The diagnosis of sSC was confirmed based on characteristic clinical and morphological features, applying our diagnostic algorithm suited for critically ill patients. We were able to characterise these sSC patients and differentiate their presentation from takotsubo registry population. Data on selected patients was extracted manually on Microsoft Excel worksheets with relevant patient demographics, presenting features and outcomes.

Results: We developed a profile of sSC based on 18 consecutive confirmed cases diagnosed at our university hospital between April 2016 and September 2018. sSC differed from takotsubo cardiomyopathy in several key clinical aspects - younger people may develop sSC (range 21-86 years) and men were more frequently affected in comparison to takotsubo cardiomyopathy (29%). Dyspnoea was noted in 22% of our patients and angina was rare. Apical ballooning occurred in only 33% of the patients, while mid (39%) and basal left ventricular (11%) variants accounted for half of the patients. Mortality was much higher (28%) due to underlying medical comorbidities.

Conclusions: Our series illustrates significant clinical and morphologic differences in the presentation of sSC. Shifting the emphasis to serial echocardiography would reduce the need for invasive catheterisation and downstream comorbidity in critical care settings.