Stress cardiomyopathy in critical care: A case series of 109 patients

Table 2 Stress cardiomyopathy diagnosis, complications and outcomes by unit

	Overall, n = 109	MSICU, (n = 49)	CCU, (n = 60)	P value1
Confirmed SC	62 (56.9)	12 (24.5)	50 (83.3)	< 0.0001
Clinical SC	47 (43.1)	37 (75.5)	10 (16.7)
Hospital day of diagnosis1; median [IQR]	2 [1-3]	3 [2-4]	1 [1-2]	0.0002
Diagnostic Studies – n (%)
Cardiac catherization	62 (56.9)	12 (24.5)	50 (83.3)	< 0.001
Transthoracic echo	109 (100)	49 (100)	60 (100)
Lowest ejection fraction – (%); median [IQR]	35 [28-40]	30 [30-40]	35 [30-45]	0.38
TTE anatomical variant- n (%)
Atypical	22 (20.2)	12 (24.5)	10 (16.7)	0.31
Typical	87 (79.8)	37 (75.5)	50 (83.3)
Type of SC- n (%)				< 0.001
Primary	43 (39.4)	0 (0.0)	43 (71.6)
Secondary	66 (60.5)	49 (100.0)	17 (28.3)
EKG Findings- n (%)
Normal EKG	21 (19.2)	14 (28.6)	7 (11.7)	0.03
ST-Segment elevation	54 (49.5)	15 (30.6)	39 (65.0)	< 0.001
ST-Segment depression	4 (3.7)	2 (4.08)	2 (3.3)	1.00
T-Wave inversion	23 (21.1)	13 (26.5)	10 (16.7)	0.24
Other	25 (22.9)	14 (28.6)	11 (18.3)	0.25
Complications – n (%)
ECMO/IABP use	3 (2.8)	1 (2.0)	2 (3.3)	1.00
Inotrope use	10 (9.2)	7 (14.3)	3 (5)	0.11
New arrythmia	14 (12.8)	5 (10.2)	9 (15.0)	0.57
AKI	37 (33.9)	21 (42.9)	16 (26.7)	0.08
RRT	14 (12.8)	4 (8.2)	2 (3.3)	0.41
Acute respiratory failure – n (%)
Mechanical ventilation	44 (40.4)	29 (59.2)	15 (25.0)	< 0.001
NIPPV only	15 (13.8)	8 (16.3)	7 (11.7)	0.48
Shock – n (%)	41 (37.6)	29 (59.2)	12 (20.0)	< 0.001
Cardiogenic shock	14 (12.8)	5 (10.2)	9 (15.0)	0.46
Septic shock	28 (25.7)	23 (46.9)	5 (8.3)	< 0.001
Other shock	2 (1.8)	2 (4.1)	0 (0.0)	0.11
Follow-up echocardiogram- n (%)
Repeat echo (% Total)	69 (63.3)	30 (61.2)	39 (65.0)	0.69
Reversibility (% Echo)	69 (100.0)	30/30 (100.0)	39/39 (100.0)	1.00
Clinical SC patients
Repeat Echo (% Total)	27/47 (57.4)	21/47 (44.7)	6/47 (12.8)	0.01
Reversibility (% Echo)	27/27 (100.0)	21/21 (100.0)	6/6 (100.0)	1.00
Hospital outcomes – n (%)
In-hospital mortality	15 (13.8)	9 (18.4)	6 (10)	0.27
ICU mortality	8 (7.3)	3 (6.1)	5 (8.3)	0.73

¹n = 3 patients diagnosed prior to intensive care unit admission, corresponds to chi-square or Fisher’s exact test for association for categorical variables, Wilcoxon Mann-Whitney test for continuous variables.

27 patients with clinical SC got follow up echocardiogram, reversibility seen in all of them. Data are summarized as median (IQR) or n (%), where n = available sample size. SC: Stress cardiomyopathy; MSICU: Medical surgical intensive care unit; CCU: Coronary care unit; EKG: Electrocardiogram; ECMO: Extracorporeal membrane oxygenation; IABP: Intraaortic balloon pump; AKI: Acute kidney injury; RRT: Renal replacement therapy; NIPPV: Non invasive positive pressure ventilation.