Downloaded from http://heart.bmj.com/ on February 26, 2015 - Published by group.bmj.com
PostScript
Takotsubo cardiomyopathy Dear Editor we read with great interest the article published by Ghadri et al.1 As the authors captivatingly described, takotsubo cardiomyopathy (TTC) is definitely a disease entity where much more is to be unravelled. TTC holds interesting nomenclature, epidemiology, trigger, disease course and imaging findings. Our data on arrhythmias in TTC showed that 4% patients had ventricular arrhythmias and nearly 2% an association with sudden cardiac arrest (SCA).2 Identifying the subset of patients who are likely to develop life-threatening arrhythmias and navigating the epidemiological profile of the patients with TTC and SCA are definitely important clinical questions which remains unanswered at this time. Further, quantifying the recurrence risk of the disease, genetic predisposition, and primary and secondary prevention strategies are some other pieces of the puzzle. Development of a TTC registry will definitely help putting the puzzle pieces together. We had suggested starting a national registry in the USA to understand this clinical entity better.3 We congratulate the University Hospital of Zurich and the authors for establishing an international registry to advance the knowledge on this disease. Sadip Pant,1 Nileshkumar J Patel,2 Abhishek Deshmukh3 1
Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
1816
Heart November 2014 Vol 100 No 22
Downloaded from http://heart.bmj.com/ on February 26, 2015 - Published by group.bmj.com
PostScript 2
Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY 3 Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, AR Correspondence to Dr Sadip Pant, Department of Cardiology, University of Arkansas for Medical Sciences, 4301 W Markham, Little Rock, AR 72205, USA; [email protected] Contributors SP: design and draft. AD: literature review, concept and referencing. NJP: concept, proofread. Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed.
To cite Pant S, Patel NJ, Deshmukh A. Heart 2014;100:1816–1817. Received 13 April 2014 Accepted 15 April 2014 Published Online First 16 May 2014
Table 1 Prehospital 12-lead electrocardiogram (PHECG) use and sex in patients who came via emergency medical services
All patients (n) Female Patients’ chest pain* (n) Female STEMI Female NSTEMI Female Patients’ atypical symptoms* (n) Female STEMI Female NSTEMI Female
Overall
PHECG
No PHECG
81 190 36.5% 66 695 34.5% 24 450 32.4% 42 245 35.7% 11 799 45.9% 2030 46.3% 9645 45.9%
25 210 34.8% 23 389 34.0% 12 062 32.3% 11 327 35.8% 1487 45.1% 363 43.0% 1124 45.8%
55 980 37.3% 43 306 34.7% 12 388 32.4% 30 918 35.7% 10 312 46.0% 1667 47.0% 8645 45.9%
OR estimate women vs men
95% CI
0.89
0.87 to 0.92
0.97
0.94 to 1.00
0.99
0.94 to 1.05
1.01
0.96 to 1.05
0.96
0.86 to 1.08
0.85
0.68 to 1.07
1.00
0.88 to 1.13
Crude OR with 95% CIs was calculated by logistic regression analysis. *Patients with missing information on presenting symptoms were deleted. STEMI, ST elevation myocardial infarction; NSTEMI, non-ST elevation myocardial infarction.
▸ http://dx.doi.org/10.1136/heartjnl-2013-304691 Heart 2014;100:1816–1817. doi:10.1136/heartjnl-2014-306038
REFERENCES 1
2
3
Ghadri JR, Ruschitzka F, Lüscher TF, et al. Takotsubo cardiomyopathy: still much more to learn. Heart 2014;100:1804–12. Pant S, Deshmukh A, Mehta K, et al. Burden of arrhythmias in patients with Takotsubo Cardiomyopathy (apical ballooning syndrome). Int J Cardiol 2013;170:64–8. Deshmukh A, Pant S, Badheka A, et al. Seasonal variation of takotsubo cardiomyopathy. Am J Cardiol 2013;111:627–8.
Heart November 2014 Vol 100 No 22
1817
Downloaded from http://heart.bmj.com/ on February 26, 2015 - Published by group.bmj.com
Takotsubo cardiomyopathy Sadip Pant, Nileshkumar J Patel and Abhishek Deshmukh Heart 2014 100: 1816-1817 originally published online May 16, 2014
doi: 10.1136/heartjnl-2014-306038 Updated information and services can be found at: http://heart.bmj.com/content/100/22/1816.1
These include:
References Email alerting service
This article cites 3 articles, 1 of which you can access for free at: http://heart.bmj.com/content/100/22/1816.1#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
PostScript
Takotsubo cardiomyopathy Dear Editor we read with great interest the article published by Ghadri et al.1 As the authors captivatingly described, takotsubo cardiomyopathy (TTC) is definitely a disease entity where much more is to be unravelled. TTC holds interesting nomenclature, epidemiology, trigger, disease course and imaging findings. Our data on arrhythmias in TTC showed that 4% patients had ventricular arrhythmias and nearly 2% an association with sudden cardiac arrest (SCA).2 Identifying the subset of patients who are likely to develop life-threatening arrhythmias and navigating the epidemiological profile of the patients with TTC and SCA are definitely important clinical questions which remains unanswered at this time. Further, quantifying the recurrence risk of the disease, genetic predisposition, and primary and secondary prevention strategies are some other pieces of the puzzle. Development of a TTC registry will definitely help putting the puzzle pieces together. We had suggested starting a national registry in the USA to understand this clinical entity better.3 We congratulate the University Hospital of Zurich and the authors for establishing an international registry to advance the knowledge on this disease. Sadip Pant,1 Nileshkumar J Patel,2 Abhishek Deshmukh3 1
Department of Internal Medicine, University of Arkansas for Medical Sciences, Little Rock, AR
1816
Heart November 2014 Vol 100 No 22
Downloaded from http://heart.bmj.com/ on February 26, 2015 - Published by group.bmj.com
PostScript 2
Department of Internal Medicine, Staten Island University Hospital, Staten Island, NY 3 Department of Cardiovascular Medicine, University of Arkansas for Medical Sciences, Little Rock, AR Correspondence to Dr Sadip Pant, Department of Cardiology, University of Arkansas for Medical Sciences, 4301 W Markham, Little Rock, AR 72205, USA; [email protected] Contributors SP: design and draft. AD: literature review, concept and referencing. NJP: concept, proofread. Competing interests None. Provenance and peer review Not commissioned; internally peer reviewed.
To cite Pant S, Patel NJ, Deshmukh A. Heart 2014;100:1816–1817. Received 13 April 2014 Accepted 15 April 2014 Published Online First 16 May 2014
Table 1 Prehospital 12-lead electrocardiogram (PHECG) use and sex in patients who came via emergency medical services
All patients (n) Female Patients’ chest pain* (n) Female STEMI Female NSTEMI Female Patients’ atypical symptoms* (n) Female STEMI Female NSTEMI Female
Overall
PHECG
No PHECG
81 190 36.5% 66 695 34.5% 24 450 32.4% 42 245 35.7% 11 799 45.9% 2030 46.3% 9645 45.9%
25 210 34.8% 23 389 34.0% 12 062 32.3% 11 327 35.8% 1487 45.1% 363 43.0% 1124 45.8%
55 980 37.3% 43 306 34.7% 12 388 32.4% 30 918 35.7% 10 312 46.0% 1667 47.0% 8645 45.9%
OR estimate women vs men
95% CI
0.89
0.87 to 0.92
0.97
0.94 to 1.00
0.99
0.94 to 1.05
1.01
0.96 to 1.05
0.96
0.86 to 1.08
0.85
0.68 to 1.07
1.00
0.88 to 1.13
Crude OR with 95% CIs was calculated by logistic regression analysis. *Patients with missing information on presenting symptoms were deleted. STEMI, ST elevation myocardial infarction; NSTEMI, non-ST elevation myocardial infarction.
▸ http://dx.doi.org/10.1136/heartjnl-2013-304691 Heart 2014;100:1816–1817. doi:10.1136/heartjnl-2014-306038
REFERENCES 1
2
3
Ghadri JR, Ruschitzka F, Lüscher TF, et al. Takotsubo cardiomyopathy: still much more to learn. Heart 2014;100:1804–12. Pant S, Deshmukh A, Mehta K, et al. Burden of arrhythmias in patients with Takotsubo Cardiomyopathy (apical ballooning syndrome). Int J Cardiol 2013;170:64–8. Deshmukh A, Pant S, Badheka A, et al. Seasonal variation of takotsubo cardiomyopathy. Am J Cardiol 2013;111:627–8.
Heart November 2014 Vol 100 No 22
1817
Downloaded from http://heart.bmj.com/ on February 26, 2015 - Published by group.bmj.com
Takotsubo cardiomyopathy Sadip Pant, Nileshkumar J Patel and Abhishek Deshmukh Heart 2014 100: 1816-1817 originally published online May 16, 2014
doi: 10.1136/heartjnl-2014-306038 Updated information and services can be found at: http://heart.bmj.com/content/100/22/1816.1
These include:
References Email alerting service
This article cites 3 articles, 1 of which you can access for free at: http://heart.bmj.com/content/100/22/1816.1#BIBL Receive free email alerts when new articles cite this article. Sign up in the box at the top right corner of the online article.
Notes
To request permissions go to: http://group.bmj.com/group/rights-licensing/permissions To order reprints go to: http://journals.bmj.com/cgi/reprintform To subscribe to BMJ go to: http://group.bmj.com/subscribe/
