Exhaustive review and triggering factors precipitating Takotsubo cardiomyopathy induced during dobutamine stress echocardiography

Our purpose was to make an exhaustive research of TTC-DSE reports and compared this cohort to a large retrospective sample of DSE exams, to identify factors which could possibly induced TTC-DSE. Between 2006 and 2019, we identify 30 observations of TTC-DSE, all of them with typical features of TTC. Over a three-year period (2013–2015), a sample of 578 consecutive patients, all exams were enrolled as reference and then compared to TTC-DSE cohort. TTC-DSE cohort showed a strong predominance of aged female population > 50 years (93.3%); depression and/or anxiety (26.7%); EKG: ST elevation (70%); normal coronary angiography; depressed angiographic left ventricular ejection fraction < 40% (14/18 pts); typical segmental LV impairment: apical (7.3%); mid-ventricular (13.6%); reverse (9%); low troponin peak: 2.65 ± 2.04 ng/mL; one death (acute heart failure), but rapid recovery of LVEF (29/30 pts). On a 3-year retrospective period (2013–2015), The 578 consecutive DSE patients were compared with TTC-DSE patients: mean age (70 vs. 64), peak dose dobutamine (30 vs. 40 μg/kg/min), maximum peak heart rate (94 vs. 81%), smoking (16 vs. 36.6%), all P < 0.01. In a multivariate analysis, female sex (OR = 9.6; 95% CI: 3–28), smoker (OR = 4.8; 95% CI: 2–11) and dobutamine posology (OR = 1.07; 95% CI: 1.02–1.12), all P < 0.01, were independent predictors of TTC-DSE. Using ROC curve analysis, dobutamine posology > 30 gammas/kg/min gives the best cut off (AUC 0.7 ± 0.04; P < 0.01). TTC-DSE is rare and superimposable to the usual TTC. By comparison with DSE, independent factors (female sex, smoker, dobutamine posology > 30 gammas/kg/min) are predictive of TTC-DSE. Nevertheless, the discrepancy between the large number of daily DSE examinations and the rarity of TTC-DSE remains unexplained.