The association between anemia and Takotsubo cardiomyopathy (TCM) has not been well studied. To assess the effect of anemia on patients hospitalized with TCM, we identified 4733 patients with a primary diagnosis of TCM from the 2016 to 2018 National Inpatient Sample (NIS) database (the United States) using the International Classification of Diseases, 10th edition, Clinical Modification (ICD-10-CM) code. Of these, 603 (12.7%) patients had a comorbidity of anemia and 4130 did not. After propensity score matching, we compared the in-hospital outcomes between the 2 groups (anemia vs nonanemia, n = 594 vs 1137). Patients with TCM with anemia had significantly higher rates of in-hospital complications, including cardiogenic shock (11.4% vs 4.0%, P < .001), ventricular arrhythmia (6.6% vs 3.6%, P = .008), acute kidney injury (22.7% vs 13.1%, P < .001), acute respiratory failure (22.6% vs 13.1%, P < .001), longer length of hospital stay (5.6 ± 5.8 days vs 3.6 ± 3.6 days, P < .001), and higher total charges (US$79 586 ± 10 2436 vs US$50 711 ± 42 639, P < .001). In conclusion, patients with anemia who were admitted for TCM were associated with a higher incidence of in-hospital complications compared with those without anemia.
SatoH. Tako-tsubo-like left ventricular dysfunction due to multivessel coronary spasm. in: K KodamaKHoriHaze M, eds. Clinical Aspect of Myocardial Injury: From Ischemia to Heart Failure. Tokyo: Kagakuhyoronsha Publishing Co; 1990. p56–64; (Article in Japanese).
2.
SyFBasraonJZhengH, et al.Frequency of Takotsubo cardiomyopathy in postmenopausal women presenting with an acute coronary syndrome. Am J Cardiol2013;112:479–82.
3.
HurstRTPrasadAAskewJW, et al.Takotsubo cardiomyopathy: a unique cardiomyopathy with variable ventricular morphology. JACC Cardiovasc Imaging2010;3:641–9.
4.
PrasadALermanARihalCS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J2008;155:408–17.
5.
LyonARBossoneESchneiderB, et al.Current state of knowledge on Takotsubo syndrome: a Position Statement from the Taskforce on Takotsubo Syndrome of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail2016;18.
6.
GhadriJ-RWittsteinISPrasadA, et al.International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology. Eur Heart J2018; 39: 2032–2046.
7.
TemplinCGhadriJRDiekmannJ, et al.Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. N Engl J Med2015; 373: 929–938.
8.
GhadriJRKatoKCammannVL, et al.Long-Term Prognosis of Patients With Takotsubo Syndrome. J Am Coll Cardiol2018; 72: 874–882.
9.
ManfrediniRCappadonaRFabbianF. Is Takotsubo Syndrome Still a Benign Disease? Complications (and Gender) Make the Difference. Angiology2019; 70: 795–796.
10.
DesaiRSinghSBaikpourM, et al.Does obesity affect the outcomes in takotsubo cardiomyopathy? Analysis of the Nationwide Inpatient Sample database, 2010-2014. Clin Cardiol2018; 41: 1028–1034.
11.
LiPLuXTengC, et al.The Association Between Hyperlipidemia and In-Hospital Outcomes in Takotsubo Cardiomyopathy. Diabetes Metab Syndr Obes. 2021;14:117–126.
12.
StiermaierTSantoroFEl-BattrawyI, et al.Prevalence and Prognostic Impact of Diabetes in Takotsubo Syndrome: Insights From the International, Multicenter GEIST Registry. Diabetes Care2018; 41: 1084–1088.
13.
KimHSenecalCLewisB, et al.Natural history and predictors of mortality of patients with Takotsubo syndrome. Int J Cardiol2018; 267: 22–27.
14.
LiPDaiQCaiP, et al.Identifying different phenotypes in takotsubo cardiomyopathy by latent class analysis. ESC Heart Fail2020.
15.
YassinASAdegbalaOSubahiA, et al.Clinical impact of advanced chronic kidney disease on outcomes and in-hospital complications of Takotsubo Syndrome (broken-heart-syndrome): Propensity-matched national study. Int J Cardiol2019; 277: 16–19.
16.
LiPLuXTengC, et al.The Impact of COPD on in-Hospital Outcomes in Patients with Takotsubo Cardiomyopathy. Int J Chron Obstruct Pulmon Dis2020; 15: 2333–2341.
17.
GuralnikJMEisenstaedtRSFerrucciLKleinHGWoodmanRC. Prevalence of anemia in persons 65 years and older in the United States: evidence for a high rate of unexplained anemia. Blood2004; 104: 2263–2268.
18.
HamaguchiSTsuchihashi-MakayaMKinugawaS, et al.Anemia is an independent predictor of long-term adverse outcomes in patients hospitalized with heart failure in Japan. A report from the Japanese Cardiac Registry of Heart Failure in Cardiology (JCARE-CARD). Circ J2009; 73: 1901–1908.
19.
DauermanHLLessardDYarzebskiJGoreJMGoldbergRJ. Bleeding complications in patients with anemia and acute myocardial infarction. Am J Cardiol2005; 96: 1379–1383.
20.
MamasMAKwokCSKontopantelisE, et al.Relationship Between Anemia and Mortality Outcomes in a National Acute Coronary Syndrome Cohort: Insights From the UK Myocardial Ischemia National Audit Project Registry. J Am Heart Assoc2016; 5.
21.
YerasiCTripathiBBangaS, et al.Predictors of 90-Day Readmission and in-Hospital Mortality in Takotsubo Cardiomyopathy: An Analysis of 28,079 Index Admissions. Cardiovasc Revasc Med2019; 20: 973–979.
22.
HCUP Nationwide Inpatient Sample (NIS), Healthcare Cost and Utilization Project (HCUP), Agency for Healthcare Research and Quality, Rockville, MD, https://www.hcup-us.ahrq.gov/nisoverview.jsp. [accessed 09/01/2020].
23.
ZhangZKimHJLonjonGZhuY. Balance diagnostics after propensity score matching. Ann Transl Med2019; 7: 16.
24.
LawlerPRFilionKBDourianTAtallahRGarfinkleMEisenbergMJ. Anemia and mortality in acute coronary syndromes: a systematic review and meta-analysis. Am Heart J2013; 165.
25.
SabatineMSMorrowDAGiuglianoRP, et al.Association of hemoglobin levels with clinical outcomes in acute coronary syndromes. Circulation2005; 111: 2042–2049.
26.
McClellanWMFlandersWDLangstonRDJurkovitzCPresleyR. Anemia and renal insufficiency are independent risk factors for death among patients with congestive heart failure admitted to community hospitals: a population-based study. J Am Soc Nephrol2002; 13: 1928–1936.
27.
KosiborodMSmithGLRadfordMJFoodyJMKrumholzHM. The prognostic importance of anemia in patients with heart failure. Am J Med2003; 114: 112–119.
28.
WestenbrinkBDAlingsMGrangerCB, et al.Anemia is associated with bleeding and mortality, but not stroke, in patients with atrial fibrillation: Insights from the Apixaban for Reduction in Stroke and Other Thromboembolic Events in Atrial Fibrillation (ARISTOTLE) trial. Am Heart J2017; 185: 140–149.
29.
MetivierFMarchaisSJGuerinAPPannierBLondonGM. Pathophysiology of anaemia: focus on the heart and blood vessels. Nephrol Dial Transplant2000; 15Suppl 3: 14–18.
30.
WittsteinISThiemannDRLimaJAC, et al.Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med2005; 352: 539–548.
31.
WeissGGanzTGoodnoughLT. Anemia of inflammation. Blood2019; 133: 40–50.
32.
CiutacAMDawsonD. The role of inflammation in stress cardiomyopathy. Trends Cardiovasc Med2020.
33.
BissingerRBhuyanAAMQadriSMLangF. Oxidative stress, eryptosis and anemia: a pivotal mechanistic nexus in systemic diseases. FEBS J2019; 286: 826–854.
34.
UeyamaTKawabeTHanoT, et al.Upregulation of heme oxygenase-1 in an animal model of Takotsubo cardiomyopathy. Circ J2009; 73: 1141–1146.
35.
SreenivasanJZhuoMKhanMS, et al.Anemia (Hemoglobin ≤ 13 g/dL) as a Risk Factor for Contrast-Induced Acute Kidney Injury Following Coronary Angiography. Am J Cardiol2018; 122: 961–965.
36.
OwCPCNgoJPUllahMMHilliardLMEvansRG. Renal hypoxia in kidney disease: Cause or consequence?Acta Physiol (Oxf)2018; 222: e12999.
37.
Regulation of Tissue Oxygenation. San Rafael (CA): Morgan & Claypool Life Sciences, 2011.
38.
NordykeRJKimJJGoldbergGA, et al.Impact of anemia on hospitalization time, charges, and mortality in patients with heart failure. Value Health2004; 7: 464–471.
39.
AllenLAAnstromKJHortonJRShawLKEisensteinELFelkerGM. Relationship between anemia and health care costs in heart failure. J Card Fail2009; 15: 843–849.
40.
KimLKYeoICheungJW, et al.Thirty-Day Readmission Rates, Timing, Causes, and Costs after ST-Segment-Elevation Myocardial Infarction in the United States: A National Readmission Database Analysis 2010-2014. J Am Heart Assoc2018; 7: e009863.
41.
MuellerMMVan RemoortelHMeybohmP, et al.Patient Blood Management: Recommendations From the 2018 Frankfurt Consensus Conference. JAMA2019; 321: 983–997.
42.
CarsonJLGuyattGHeddleNM, et al.Clinical Practice Guidelines From the AABB: Red Blood Cell Transfusion Thresholds and Storage. JAMA2016; 316: 2025–2035.
43.
CarsonJLBrooksMMAbbottJD, et al.Liberal versus restrictive transfusion thresholds for patients with symptomatic coronary artery disease. Am Heart J2013; 165.
Supplementary Material
Please find the following supplemental material available below.
For Open Access articles published under a Creative Commons License, all supplemental material carries the same license as the article it is associated with.
For non-Open Access articles published, all supplemental material carries a non-exclusive license, and permission requests for re-use of supplemental material or any part of supplemental material shall be sent directly to the copyright owner as specified in the copyright notice associated with the article.
