Sex differences of in-hospital outcome and long-term mortality in patients with Takotsubo cardiomyopathy

Figures & data

Table 1 Baseline characteristics of patients with TTC according to sex difference

Variables	Female (n=95)	Male (n=19)	P-value*
Demographics
Age, mean ± SD	67.72±11.33	64.37±10.60	0.23
Symptoms, n (%)
Dyspnea	36 (37.89)	7 (36.84)	0.93
Chest pain	51 (53.68)	7 (36.84)	0.18
Clinic parameter, mean ± SD
Systolic BP, mmHg	131.96±29.78	128.68±42.19	0.69
Diastolic BP, mmHg	76.81±14.46	76.00±27.42	0.87
Heart rate, bpm	98.55±25.87	109.89±31.35	0.10
ECG data, n (%)
ST-segment elevation	31 (32.63)	3 (15.78)	0.17
Inversed T-waves	84 (88.42)	18 (94.73)	0.55
PQ interval	158.56±27.71	169.22±34.26	0.16
QTc (ms), mean ± SD	483.24±53.45	459.42±42.30	0.07
Stress factor, n (%)
Emotional stress	28 (29.47)	2 (10.52)	0.15
Physical stress	52 (54.73)	12 (63.15)	0.49
None	20 (21.05)	5 (26.31)	0.56
Laboratory values, mean ± SD
Troponin I (U/L)	3.38±4.90	5.54±7.17	0.12
Creatine phosphokinase (U/L)	350.77±756.58	2,173.94±6,201.52	<0.01
CKMB	30.42.±32.94	58.91±116.16	0.14
CRP (mg/L)	47.47±78.78	58.97±85.30	0.57
Hemoglobin	12.19±1.75	11.87±2.96	0.52
Creatinine (mg/dL)	1.11±0.72	1.35±0.67	0.18
Echocardiography data, n (%)
LV EF%	38.67±9.28	36.95±10.51	0.47
RV involvement	20 (21)	6 (31.5)	0.37
Apical ballooning	67 (70.52)	15 (78.94)	0.77
Mitral regurgitation	51 (53.68)	9 (47.36)	0.61
Tricuspid regurgitation	41 (43.15)	8 (42.10)	0.93
Medical history, n (%)
Smoking	26 (27.36)	10 (52.63)	0.03
Diabetes mellitus	22 (23.15)	4 (21.05)	1.00
Obesity (BMI >25 kg/m^2)	25 (26.31)	6 (31.57)	0.47
Hypertension	55 (57.89)	11 (57.89)	1.00
COPD	16 (16.84)	6 (31.57)	0.13
Atrial fibrillation	18 (18.94)	3 (15.78)	1.00
Coronary artery disease	17 (17.89)	5 (26.31)	0.52
History of malignancy	11 (11.57)	5 (26.31)	0.14
Drugs on admission, n (%)
Beta blocker	30 (31.57)	5 (26.31)	0.43
ACE inhibitor	28 (29.47)	7 (36.84)	0.88
Acetylsalicylic acid	24 (25.26)	5 (26.31)	1.00
Anticoagulation	7 (7.36)	0 (0)	0.34

Note:

* P-values for the comparison between female and male groups.

Abbreviations: TTC, Takotsubo cardiomyopathy; SD, standard deviation; BP, blood pressure; ECG, electrocardiogram; CKMB, creatine kinase myocardial band; CRP, C-reactive protein; LV, left ventricular; EF, ejection fraction; RV, right ventricular; BMI, body mass index; COPD, chronic obstructive pulmonary disease; ACE, angiotensin-converting enzyme.

Table 2 In-hospital events and treatment strategy of TTC patients according to sex difference

Variables	Female (n=95)	Male (n=19)	P-value*
Life-threatening arrhythmia, n (%)	10 (10.52)	3 (15.78)	0.45
Mechanical respiratory support (NPPV and intubation), n (%)	29 (30.52)	10 (52.63)	0.06
Inotropic agents, n (%)	15 (15.78)	6 (31.57)	0.10
Resuscitation, n (%)	6 (6.31)	3 (15.78)	0.17
Defibrillator implantation, n (%)	1 (1.05)	0 (0)	1.00
VA-ECMO, n (%)	0 (0)	1 (5.2)	1.00
Admission to ICU, length of stay, mean ± SD	4.14±6.39	5.94±5.73	0.26
In-hospital death	6 (6.31)	3 (15.78)	0.17
Thromboembolic events	13 (13.68)	1 (5.26)	0.45
Acquired long QTs	61 (64.21)	12 (63.15)	0.50
Cardiogenic shock	17 (17.89)	5 (26.31)	0.54

Note:

* P-values for the comparison between female and male groups.

Abbreviations: TTC, Takotsubo cardiomyopathy; NPPV, non-invasive positive-pressure ventilation; VA-ECMO, venoarterial extracorporeal membrane oxygenation; ICU, intermediate care unit; SD, standard deviation.

Figure 1 Survival analysis (Kaplan–Meier analysis): survival time of all patients with TTC – a comparison between female and male patients.

Abbreviation: TTC, Takotsubo cardiomyopathy.

Table 3 Univariate and multivariate Cox regression analyses of TTC patients show that male sex is an independent predictor of adverse outcome, all-cause mortality after 5 years

Variable	Univariate analysis			Multivariate analysisa
	HR	95% CI	P-value	HR	95% CI	P-value
Male	2.6	1.2–5.7	0.01	2.8	1.1–7.2	0.02
CRP	1.0	1.0–1.0	<0.01	1.0	0.9–1.0	0.36
GFR ≤60 mL/min	2.5	1.2–5.1	0.01	3.1	1.4–7.0	<0.01
Cardiogenic shock	4.1	2.0–8.4	<0.01	3.8	0.6–23.4	0.13
EF ≤35%	4.8	2.2–104	<0.01	3.3	1.2–9.2	0.01
Emotional stress	0.4	0.1–1.1	0.10
Inotropic drugs	3.9	1.9–7.9	<0.01	0.4	0.0–2.8	0.40
Diabetes mellitus	1.0	0.7–1.4	0.81
Type II
Hypertension	0.9	0.7–1.2	0.64
Apical ballooning	1.1	0.8–1.4	0.39
History of cancer	1.7	0.7–4.2	0.21
Smoking	0.7	0.3–1.6	0.49

Note:

a Only the following variables with significant effects in univariate analysis were analyzed by multivariate Cox regression: male, CRP, GFR ≤60 mL/min, cardiogenic shock, EF ≤35% and inotropic drugs.

Abbreviations: TTC, Takotsubo cardiomyopathy; HR, hazard ratio; CRP, C-reactive protein; GFR, glomerular filtration rate; EF, ejection fraction.