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

doi:10.5492/wjccm.v11.i3.149

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World Journal of Critical Care Medicine

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Retrospective Study

World J Crit Care Med. May 9, 2022; 11(3): 149-159
Published online May 9, 2022. doi: 10.5492/wjccm.v11.i3.149

Table 1 Patient baseline characteristics and presentation by unit

	Overall, n = 109	MSICU, (n = 49)	CCU, (n = 60)	P value¹
Age (yr), mean (SD)	67.2 (14.2)	64.9 (14.4)	69 (13.7)	0.13
Female gender – n (%)	78 (71.6)	30 (61.2)	48 (80.0)	0.04
Race/Ethnicity – n (%)				0.37
White	30 (27.5)	17 (34.7)	13 (21.7)
Black	20 (18.4)	9 (18.4)	11 (18.3)
Hispanic	42 (38.5)	15 (30.6)	27 (45.0)
Other	17 (15.6)	8 (16.3)	9 (15.0)
Comorbidities – n (%)
Diabetes mellitus	40 (36.7)	19 (38.8)	21 (35)	0.68
Hypertension	65 (59.6)	23 (46.9)	42 (70)	0.01
Coronary disease	13 (11.9)	5 (10.2)	8 (13.3)	0.77
Heart failure	7 (6.4)	4 (8.2)	3 (5)	0.70
Arrhythmia	14 (12.8)	4 (8.2)	10 (16.7)	0.25
Asthma	16 (14.7)	6 (12.2)	10 (16.7)	0.52
COPD	13 (11.9)	6 (12.2)	7 (11.7)	0.93
Obesity	10 (9.2)	3 (6.1)	7 (11.7)	0.51
CKD	14 (12.8)	8 (16.3)	6 (10)	0.33
ESRD	3 (2.8)	1 (2)	2 (3.3)	1.00
Cancer	23 (21.1)	10 (20.4)	13 (21.7)	1.00
Cirrhosis	6 (5.5)	5 (10.2)	1 (1.7)	0.09
HIV	2 (1.8)	1 (2)	1 (1.7)	1.00
Social risk factors – n (%)
Alcohol use	25 (22.9)	13 (26.5)	12 (20)	0.42
Current smoker	15 (13.8)	4 (8.2)	11 (18.3)	0.17
Former smoker	36 (33)	21 (42.9)	15 (25)	0.05
Presenting symptoms- n (%)
Chest pain	35 (32.1)	8 (16.3)	27 (45)	0.001
SOB	55 (50.5)	23 (46.9)	32 (53.3)	0.51
Shock	41 (37.6)	29 (59.2)	12 (20)	< 0.001
Reason for unit admission- n (%)
Cardiac	44 (40.3)	0 (0.0)	44 (73.3)	< 0.001
Respiratory	14 (12.8)	9 (18.4)	5 (8.3)	0.54
Sepsis	24 (22.0)	19 (38.8)	5 (8.3)	< 0.001
GI	11 (10.0)	9 (18.4)	2 (3.3)	0.14
Neurological	7 (6.4)	6 (12.2)	1 (1.7)	0.04
Metabolic	4 (3.7)	3 (6.1)	1 (1.7)	0.32
Other	5 (4.6)	3 (6.1)	2 (3.3)	0.66

¹Corresponds to chi-square or Fisher’s exact test for association for categorical variables, Wilcoxon Mann-Whitney test for continuous variables. Data are summarized as mean (SD) or n (%), where n = available sample size. MSICU: Medical surgical intensive care unit; CCU: Coronary care unit; COPD: Chronic obstructive pulmonary disease; CKD: Chronic kidney disease; ESRD: End stage renal disease; HIV: Human immunodeficiency virus; SOB: Shortness of breath; GI: Gastrointestinal.

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)	< 0.0001
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)	< 0.001
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)	0.31
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.

Table 3 Peak laboratory values by unit

	MSICU (n = 49)	CCU (n = 60)	P value¹
Troponin-T (ng/mL)	0.42 [0.23-1.2]	0.87 [0.29-1.54]	0.11
CPK (U/L)	427 [148.5-1348.5]	276.5 [161-695]	0.48
Pro-BNP (pg/mL)	5395 [1458-15000]	3363.5 [944.5-15369]	0.72

¹Corresponds to a Wilcoxon Mann-Whitney test. Data are summarized as median (IQR).

MSICU: Medical surgical intensive care unit; CCU: Coronary care unit; CPK: Creatine phosphokinase; Pro-BNP: N-terminal pro- brain natriuretic peptide.

Table 4 Peak laboratory values and outcomes of stress cardiomyopathy by anatomical variant

	Typical (n = 87)	Atypical (n = 22)	P value¹
Lab findings- median (IQR)
Troponin-T (ng/mL)	0.65 [0.23–1.57]	0.58 [0.25-0.94]	0.61
CPK (U/L)	297.5 [151-919]	278 [168-631]	0.94
Pro-BNP (pg/mL)	3722 [874-11932]	5599 [1608.5-17373.0]	0.29
Hospital complications- n (%)
Inotrope use	8 (9.2)	2 (9.1)	1
ECMO/IABP use	2 (2.3)	1 (4.5)	0.5
RRT	3 (3.4)	3 (13.6)	0.1
Hospital outcomes- n (%)
In-hospital mortality	12 (13.8)	3 (13.6)	1
ICU mortality	7 (8)	1 (4.5)	1

¹Corresponds to a Wilcoxon Mann-Whitney test.

Data are summarized as median (IQR) or n (%), where n = available sample size. CPK: Creatine phosphokinase, Pro-BNP: N-terminal pro- brain natriuretic peptide; ECMO: Extracorporeal membrane oxygenation; IABP: Intraaortic balloon pump; RRT: Renal replacement therapy; NIPPV: Non invasive positive pressure ventilation.

Citation: Pancholi P, Emami N, Fazzari MJ, Kapoor S. Stress cardiomyopathy in critical care: A case series of 109 patients. World J Crit Care Med 2022; 11(3): 149-159
URL: https://www.wjgnet.com/2220-3141/full/v11/i3/149.htm
DOI: https://dx.doi.org/10.5492/wjccm.v11.i3.149