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Takotsubo cardiomyopathy in children

Published online by Cambridge University Press:  26 August 2020

Prithvi Sendi Open the ORCID record for Prithvi Sendi [Opens in a new window] ,
Paul Martinez ,
Madhuradhar Chegondi  and
Balagangadhar R. Totapally
Prithvi Sendi*
Affiliation:
Division of Critical Care Medicine, Nicklaus Children’s Hospital & Department of Pediatrics, Miami, FL, USA Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
Paul Martinez
Affiliation:
Division of Critical Care Medicine, Nicklaus Children’s Hospital & Department of Pediatrics, Miami, FL, USA Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
Madhuradhar Chegondi
Affiliation:
Division of Critical Care Medicine, Stead Family Children’s Hospital & Department of Pediatrics, Carver College of Medicine, University of Iowa, Iowa City, IA, USA
Balagangadhar R. Totapally
Affiliation:
Division of Critical Care Medicine, Nicklaus Children’s Hospital & Department of Pediatrics, Miami, FL, USA Herbert Wertheim College of Medicine, Florida International University, Miami, FL, USA
*
Author for correspondence: Prithvi Sendi, MD, Division of Critical Care Medicine, Nicklaus Children’s Hospital, 3100 SW 62nd Avenue, Miami, FL33155, USA. Tel: +1 305 662 2639; Fax: +1 305 663 0530. E-mail: [email protected]
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Abstract

Objective:

To explore the epidemiology and outcomes of takotsubo cardiomyopathy in children.

Methods:

A retrospective analysis of the Healthcare Cost and Utilization 2012 and 2016 Kids’ Inpatient Database was performed. Patients admitted with the diagnosis of takotsubo cardiomyopathy in the age group of 1 month–20 years were identified using International Classification of Diseases (ICD)-9 code 429.83 and ICD-10 code I51.81.

Results:

Among a total of 4,860,859 discharges, there were 153 with the diagnosis of takotsubo cardiomyopathy (3.1 per 100,000 discharges). Among patients with takotsubo cardiomyopathy, 55.0% were male, 62.4% were white, and 16.7% were black. Eighty-nine percent of patients were between 12 and 20 years. Psychiatric diagnosis was documented in 46% and substance use disorder in 36.2%. Sepsis was documented in 22.8% of patients. The median length of stay was 5 days (interquartile range: 2.7–15), and median total charges were $75,080 (interquartile range: 32,176–198,336). The overall mortality for takotsubo cardiomyopathy was 7%. On multivariable regression analysis, mortality was higher in the presence of anoxic injury (odds ratio = 34.42, 95% confidence interval: 4.85–320.11, p = 0.00).

Conclusions:

Takotsubo cardiomyopathy is uncommon in children and carries a mortality rate of 7%. Most children with takotsubo cardiomyopathy are adolescent males, many of whom have psychiatric disorder or substance use disorder or both. Takotsubo cardiomyopathy should be considered in the differential diagnosis for patients who present with cardiac dysfunction and have underlying psychiatric disorders or drug abuse.

Keywords

Takotsubo cardiomyopathycardiomyopathychildheart failureKids’ Inpatient Databasemortality
Type
Original Article
Information
Cardiology in the Young , Volume 30 , Issue 11 , November 2020 , pp. 1711 - 1715
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Copyright
© The Author(s), 2020. Published by Cambridge University Press

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References

Sato, H, Taiteishi, H, Uchida, T, et al. Takotsubo-type cardiomyopathy due to multivessel spasm. In: Kodama, K, Haze, K, Hon, M (eds). Clinical Aspect of Myocardial Injury: From Ischemia to Heart Failure. Kagakuhyouronsha, Tokyo, 1990: 56.Google Scholar
Medeiros, K, O’Connor, MJ, Baicu, CF, et al. Systolic and diastolic mechanics in stress cardiomyopathy. Circulation 2014; 129: 1659–1667. doi: 10.1161/CIRCULATIONAHA.113.002781 CrossRefGoogle ScholarPubMed
Hurst, RT, Prasad, A, Askew, JW, 3rd, Sengupta, PP, Tajik, AJ. Takotsubo cardiomyopathy: a unique cardiomyopathy with variable ventricular morphology. JACC Cardiovasc Imaging. 2010; 3: 641–649. doi: 10.1016/j.jcmg.2010.01.009 CrossRefGoogle ScholarPubMed
Abe, Y, Kondo, M, Matsuoka, R, Araki, M, Dohyama, K, Tanio, H. Assessment of clinical features in transient left ventricular apical ballooning. J Am Coll Cardiol 2003; 41: 737–742. doi: 10.1016/s0735-1097(02)02925-x CrossRefGoogle ScholarPubMed
Templin, C, Ghadri, JR, Diekmann, J, et al. Clinical features and outcomes of takotsubo (stress) cardiomyopathy. N Engl J Med 2015; 373: 929–938. doi: 10.1056/NEJMoa1406761 CrossRefGoogle ScholarPubMed
Sharkey, SW, Lesser, JR, Zenovich, AG, et al. Acute and reversible cardiomyopathy provoked by stress in women from the United States. Circulation 2005; 111: 472–479. doi: 10.1161/01.Cir.0000153801.51470.Eb CrossRefGoogle ScholarPubMed
Wittstein, IS, Thiemann, DR, Lima, JA, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med 2005; 352: 539–548. doi: 10.1056/NEJMoa043046 CrossRefGoogle ScholarPubMed
Park, JH, Kang, SJ, Song, JK, et al. Left ventricular apical ballooning due to severe physical stress in patients admitted to the medical ICU. Chest 2005; 128: 296–302. doi: 10.1378/chest.128.1.296 CrossRefGoogle ScholarPubMed
Buchholz, S, Rudan, G. Tako-tsubo syndrome on the rise: a review of the current literature. Postgrad Med J 2007; 83:261–264. doi: 10.1136/pgmj.2006.052423 CrossRefGoogle ScholarPubMed
Gianni, M, Dentali, F, Grandi, AM, Sumner, G, Hiralal, R, Lonn, E. Apical ballooning syndrome or takotsubo cardiomyopathy: a systematic review. Eur Heart J 2006; 27: 1523–1529. doi: 10.1093/eurheartj/ehl032 CrossRefGoogle ScholarPubMed
Kurisu, S, Sato, H, Kawagoe, T, et al. Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction. Am Heart J 2002; 143: 448–455. doi: 10.1067/mhj.2002.120403 CrossRefGoogle ScholarPubMed
CCS H. Healthcare Cost and Utilization Project (HCUP). March 2017. Agency for Healthcare Research and Quality, Rockville, MD. Updated 3/6/2017. Accessed 04/01, 2020. www.hcup-us.ahrq.gov/toolssoftware/ccs/ccs.jsp Google Scholar
https://www.bls.gov/cpi/tables/supplemental-files/historical-cpi-u-202002.pdf.Google Scholar
Hernandez, LE. Takotsubo cardiomyopathy: how much do we know of this syndrome in children and young adults? Cardiol Young 2014; 24: 580–592. doi: 10.1017/s1047951114000080 CrossRefGoogle ScholarPubMed
Topal, Y, Topal, H, Dogan, C, Tiryaki, SB, Biteker, M. Takotsubo (stress) cardiomyopathy in childhood. Eur J Pediatr 2020; 179: 619–625. doi: 10.1007/s00431-019-03536-z CrossRefGoogle ScholarPubMed
Urbinati, A, Pellicori, P, Guerra, F, Capucci, A, Clark, AL. Takotsubo syndrome in the paediatric population: a case report and a systematic review. J Cardiovasc Med (Hagerstown) 2017; 18: 262–267. doi: 10.2459/jcm.0000000000000446 CrossRefGoogle ScholarPubMed
Kastaun, S, Schwarz, NP, Juenemann, M, et al. Cortisol awakening and stress response, personality and psychiatric profiles in patients with takotsubo cardiomyopathy. Heart 2014; 100: 1786–1792. doi: 10.1136/heartjnl-2014-305745 CrossRefGoogle ScholarPubMed
Sancassiani, F, Carta, MG, Montisci, R, et al. Takotsubo syndrome is associated with mood disorders and antidepressants use, not with anxiety and impairment of quality of life due to the psychiatric disorder. Clin Pract Epidemiol Ment Health 2018; 14: 26–32. doi: 10.2174/1745017901814010026 CrossRefGoogle Scholar
Deshmukh, A, Kumar, G, Pant, S, Rihal, C, Murugiah, K, Mehta, JL. Prevalence of takotsubo cardiomyopathy in the United States. Am Heart J 2012; 164: 66–71 e1. doi: 10.1016/j.ahj.2012.03.020 CrossRefGoogle ScholarPubMed
Del Pace, S, Parodi, G, Bellandi, B, et al. Anxiety trait in patients with stress-induced cardiomyopathy: a case–control study. Clin Res Cardiol 2011; 100: 523–529. doi: 10.1007/s00392-010-0276-x CrossRefGoogle ScholarPubMed
Suárez Bagnasco, M, Núñez-Gil, IJ. Psychological disorders in adults with inherited cardiomyopathies and takotsubo syndrome. Medwave 2016; 16: e6460. doi: 10.5867/medwave.2016.05.6460 CrossRefGoogle ScholarPubMed
Wittstein, IS. Stress cardiomyopathy: a syndrome of catecholamine-mediated myocardial stunning? Cell Mol Neurobiol 2012; 32: 847–857. doi: 10.1007/s10571-012-9804-8 CrossRefGoogle ScholarPubMed
Kume, T, Kawamoto, T, Okura, H, et al. Local release of catecholamines from the hearts of patients with Takotsubo-like left ventricular dysfunction. Circ J 2008; 72: 106–108. doi: 10.1253/circj.72.106 CrossRefGoogle Scholar
Lacy, CR, Contrada, RJ, Robbins, ML, et al. Coronary vasoconstriction induced by mental stress (simulated public speaking). Am J Cardiol 1995; 75: 503–505. doi: 10.1016/s0002-9149(99)80590-6 CrossRefGoogle Scholar
Bybee, KA, Prasad, A, Barsness, GW, et al. Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am J Cardiol 2004; 94: 343–346. doi: 10.1016/j.amjcard.2004.04.030 CrossRefGoogle ScholarPubMed
Sadamatsu, K, Tashiro, H, Maehira, N, Yamamoto, K. Coronary microvascular abnormality in the reversible systolic dysfunction observed after noncardiac disease. Jpn Circ J 2000; 64: 789–792. doi: 10.1253/jcj.64.789 CrossRefGoogle ScholarPubMed
Mann, DL, Kent, RL, Parsons, B, Gt, Cooper. Adrenergic effects on the biology of the adult mammalian cardiocyte. Circulation 1992; 85: 790-804. doi: 10.1161/01.cir.85.2.790 CrossRefGoogle ScholarPubMed
Mausbach, BT, Dimsdale, JE, Ziegler, MG, et al. Depressive symptoms predict norepinephrine response to a psychological stressor task in Alzheimer’s caregivers. Psychosom Med 2005; 67: 638–642. doi: 10.1097/01.psy.0000173312.90148.97 CrossRefGoogle ScholarPubMed
Alvarenga, ME, Richards, JC, Lambert, G, Esler, MD. Psychophysiological mechanisms in panic disorder: a correlative analysis of noradrenaline spillover, neuronal noradrenaline reuptake, power spectral analysis of heart rate variability, and psychological variables. Psychosom Med 2006; 68: 8–16. doi: 10.1097/01.psy.0000195872.00987.db CrossRefGoogle ScholarPubMed
Ghadri, JR, Wittstein, IS, Prasad, A, et al. International expert consensus document on takotsubo syndrome (part I): clinical characteristics, diagnostic criteria, and pathophysiology. Eur Heart J 2018; 39: 2032–2046. doi: 10.1093/eurheartj/ehy076 CrossRefGoogle ScholarPubMed
Kido, K, Guglin, M. Drug-induced takotsubo cardiomyopathy. J Cardiovasc Pharmacol Ther 2017; 22: 552–563. doi: 10.1177/1074248417708618 CrossRefGoogle ScholarPubMed
Sanchez, AM, Sennhauser, S, Lozier, MR, Purow, JM. Will Mary Jane leave you heartbroken? Marijuana use and risk of takotsubo cardiomyopathy. Cureus 2019; 11:e5987. doi: 10.7759/cureus.5987 Google Scholar
Nogi, M, Fergusson, D, Chiaco, JM. Mid-ventricular variant takotsubo cardiomyopathy associated with cannabinoid hyperemesis syndrome: a case report. Hawaii J Med Public Health 2014; 73: 115–118.Google ScholarPubMed
Bonz, A, Laser, M, Küllmer, S, et al. Cannabinoids acting on CB1 receptors decrease contractile performance in human atrial muscle. J Cardiovasc Pharmacol 2003; 41: 657–664.CrossRefGoogle ScholarPubMed
Fuentealba, JA, Forray, MI, Gysling, K. Chronic morphine treatment and withdrawal increase extracellular levels of norepinephrine in the rat bed nucleus of the stria terminalis. J Neurochem 2000; 75: 741–748. doi: 10.1046/j.1471-4159.2000.0750741.x CrossRefGoogle ScholarPubMed
Milanés, MV, Laorden, ML. Changes in catecholaminergic pathways innervating the rat heart ventricle during morphine dependence. Involvement of α1- and α2-adrenoceptors. Eur J Pharmacol. 2000; 397: 311–318. doi: 10.1016/S0014-2999(00)00307-1 CrossRefGoogle Scholar
Sarcon, A, Ghadri, JR, Wong, G, Luscher, TF, Templin, C, Amsterdam, E. Takotsubo cardiomyopathy associated with opiate withdrawal. QJM 2014; 107: 301–312. doi: 10.1093/qjmed/hct219 CrossRefGoogle ScholarPubMed
Cappelletti, S, Ciallella, C, Aromatario, M, Ashrafian, H, Harding, S, Athanasiou, T. Takotsubo cardiomyopathy and sepsis. Angiology 2017;68(4):288-303. doi: 10.1177/0003319716653886 CrossRefGoogle ScholarPubMed
Clemente, G, Tuttolomondo, A, Colomba, D, et al. When sepsis affects the heart: a case report and literature review. World J Clin Cases 2015; 3: 743–750. doi: 10.12998/wjcc.v3.i8.743 CrossRefGoogle ScholarPubMed
Shams, YH, Settergren, M, Henareh, L. Sepsis-induced myocardial depression and takotsubo syndrome. Acute Card Care 2014; 16: 102–109. doi: 10.3109/17482941.2014.920089 Google Scholar
Krishnagopalan, S, Kumar, A, Parrillo, JE, Kumar, A. Myocardial dysfunction in the patient with sepsis. Curr Opin Crit Care 2002; 8: 376–388. doi: 10.1097/00075198-200210000-00003 CrossRefGoogle ScholarPubMed
Vallabhajosyula, S, Deshmukh, AJ, Kashani, K, Prasad, A, Sakhuja, A. Tako-Tsubo cardiomyopathy in severe sepsis: nationwide trends, predictors, and outcomes. J Am Heart Assoc. 2018; 7: e009160. doi: 10.1161/jaha.118.009160 CrossRefGoogle Scholar