Retrospective Study
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Crit Care Med. May 9, 2022; 11(3): 149-159
Published online May 9, 2022. doi: 10.5492/wjccm.v11.i3.149
Stress cardiomyopathy in critical care: A case series of 109 patients
Parth Pancholi, Nader Emami, Melissa J Fazzari, Sumit Kapoor
Parth Pancholi, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, United States
Nader Emami, Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, United States
Melissa J Fazzari, Department of Epidemiology and Population Health, Albert Einstein College of Medicine, Bronx, NY 10461, United States
Sumit Kapoor, Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Albert Einstein College of Medicine, Bronx, NY 10467, United States
Author contributions: Pancholi P contributed with data acquisition, data analysis, and manuscript writing; Emami N contributed with data acquisition, analysis and manuscript editing; Fazzari MJ performed the data analysis; Kapoor S designed the study, contributed to manuscript writing, and provided overall supervision; all authors have read and approve the final manuscript.
Institutional review board statement: The study was approved by the Institutional Review Board of the Albert Einstein College of Medicine (IRB# 2019-10754) and waiver of informed consent was granted due to minimal risk.
Conflict-of-interest statement: The authors report no conflicts of interest.
Data sharing statement: Technical appendix, statistical code, and dataset available from the corresponding author. Participant consent was not obtained but the presented data are anonymized and risk of identification is low.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Sumit Kapoor, MD, Division of Critical Care Medicine, Department of Medicine, Montefiore Medical Center, Bronx, NY 10467, United States. drkapoorsumit@gmail.com
Received: November 22, 2021
Peer-review started: November 22, 2021
First decision: January 12, 2022
Revised: January 20, 2022
Accepted: March 16, 2022
Article in press: March 16, 2022
Published online: May 9, 2022
Processing time: 165 Days and 15.4 Hours
Abstract
BACKGROUND

Critically ill patients are at risk of developing stress cardiomyopathy (SC) but can be under-recognized.

AIM

To describe a case series of patients with SC admitted to critical care units.

METHODS

We conducted a retrospective observational study at a tertiary care teaching hospital. All adult (≥ 18 years old) patients admitted to the critical care units with stress cardiomyopathy over 5 years were included.

RESULTS

Of 24279 admissions to the critical care units [19139 to medical-surgical intensive care units (MSICUs) and 5140 in coronary care units (CCUs)], 109 patients with SC were identified. Sixty (55%) were admitted to the coronary care units (CCUs) and forty-nine (45%) to the medical-surgical units (MSICUs). The overall incidence of SC was 0.44%, incidence in CCU and MSICU was 1.16% and 0.25% respectively. Sixty-two (57%) had confirmed SC and underwent cardiac catheterization whereas 47 (43%) had clinical SC, and did not undergo cardiac catheterization. Forty-three (72%) patients in the CCUs were diagnosed with primary SC, whereas all (100%) patients in MSICUs developed secondary SC. Acute respiratory failure that required invasive mechanical ventilation and shock developed in twenty-nine (59%) MSICU patients. There were no statistically significant differences in intensive care unit (ICU) mortality, in-hospital mortality, use of inotropic or mechanical circulatory support based on type of unit or anatomical variant.

CONCLUSION

Stress cardiomyopathy can be under-recognized in the critical care setting. Intensivists should have a high index of suspicion for SC in patients who develop sudden or worsening unexplained hemodynamic instability, arrhythmias or respiratory failure in ICU.

Keywords: Stress cardiomyopathy; Critical care; Shock; Respiratory failure

Core Tip: In our retrospective study, we found that stress cardiomyopathy (SC) is often under-recognized in the critical care setting. Primary SC is commonly seen in the coronary care units and the secondary form predominates in the medical-surgical intensive care unit setting. Presentation of secondary SC is often atypical and the majority of patients have simultaneous acute respiratory failure and sepsis. High index of clinical suspicion for SC is needed in patients who develop sudden or worsening unexplained hemodynamic instability, arrhythmias or respiratory failure. Cardiac catheterization may not be always feasible to confirm the diagnosis. Routine utilization of point of care ultrasound on all intensive care unit patients will help identify more cases. The outcomes of these patients are excellent as majority of them show reversibility of cardiac function on follow up imaging.