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The Risk of Takotsubo Cardiomyopathy in Acute Neurological Disease

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Abstract

Background

Case series have reported reversible left ventricular dysfunction, also known as stress cardiomyopathy or Takotsubo cardiomyopathy (TCM), in the setting of acute neurological diseases such as subarachnoid hemorrhage. The relative associations between various neurological diseases and Takotsubo remain incompletely understood.

Methods

We performed a cross-sectional study of all adults in the National Inpatient Sample, a nationally representative sample of US hospitalizations, from 2006 to 2014. Our exposures of interest were primary diagnoses of acute neurological disease, defined by ICD-9-CM diagnosis codes. Our outcome was a diagnosis of TCM. Binary logistic regression models were used to examine the associations between our pre-specified neurological diagnoses and TCM after adjustment for demographics.

Results

Among acute neurological diagnoses, the strongest associations were seen with subarachnoid hemorrhage (odds ratio [OR] 11.7; 95% confidence interval [CI] 10.2–13.4), status epilepticus (OR 4.9; 95% CI 3.7–6.3), and seizures (OR 1.3; 95% CI 1.1–1.5). In a sensitivity analysis including secondary diagnoses of acute neurological diagnoses, associations were also seen with transient global amnesia (OR 2.3; 95% CI 1.5–3.6), meningoencephalitis (OR 2.1; 95% CI 1.7–2.5), migraine (OR 1.7; 95% CI 1.5–1.8), intracerebral hemorrhage (OR 1.3; 95% CI 1.1–1.5), and ischemic stroke (OR 1.2; 95% CI 1.1–1.3). In addition, female sex was strongly associated with Takotsubo (OR 5.1; 95% CI 4.9–5.4).

Conclusion

TCM appears to be associated with varying degrees with several acute neurological diseases besides subarachnoid hemorrhage.

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Funding

Financial support for this study was provided by Grant K23NS082367 (Dr. Kamel) from the National Institute of Neurological Disorders and Stroke and a grant from the Michael Goldberg Stroke Research Fund (Dr. Kamel).

Author information

Authors and Affiliations

  1. Department of Neurology, Program in Trauma, University of Maryland School of Medicine, Baltimore, MD, USA

    Nicholas A. Morris

  2. Clinical and Translational Neuroscience Unit, Feil Family Brain and Mind Research Institute, Weill Cornell Medical College, New York, NY, USA

    Abhinaba Chatterjee, Monica Chen, Alexander E. Merkler, Santosh B. Murthy & Hooman Kamel

  3. Division of Cardiology, Weill Cornell Medical College, New York, NY, USA

    Oluwayemisi L. Adejumo

  4. Department of Neurology, Weill Cornell Medical College, 407 East 61st Street, New York, NY, 10065, USA

    Alexander E. Merkler, Santosh B. Murthy & Hooman Kamel

Authors
  1. Nicholas A. Morris
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  2. Abhinaba Chatterjee
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  3. Oluwayemisi L. Adejumo
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  4. Monica Chen
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  7. Hooman Kamel
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Contributions

NAM conceived and designed the study, interpreted the data, drafted the article and revised it for important intellectual content, and gave final approval of the version to be published. AC acquired, analyzed, and interpreted the data, revised the article for important intellectual content, and gave final approval of the version to be published. OLA acquired the data, revised the article critically for important intellectual content, and gave final approval of the version to be published. MC acquired and analyzed the data, revised the article critically for important intellectual content, and gave final approval of the version to be published. AEM conceived and designed the study, interpreted the data, revised the article for important intellectual content, and gave final approval of the version to be published. SBM conceived and designed the study, interpreted the data, revised the article for important intellectual content, and gave final approval of the version to be published. HK conceived and designed the study, interpreted the data, revised the article for important intellectual content, and gave final approval of the version to be published.

Corresponding author

Correspondence to Hooman Kamel.

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Morris, N.A., Chatterjee, A., Adejumo, O.L. et al. The Risk of Takotsubo Cardiomyopathy in Acute Neurological Disease. Neurocrit Care 30, 171–176 (2019). https://doi.org/10.1007/s12028-018-0591-z

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  • DOI: https://doi.org/10.1007/s12028-018-0591-z

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