Sex Differences in Stress-Induced (Takotsubo) Cardiomyopathy

BACKGROUND: Takotsubo cardiomyopathy (TC) affects predominantly women. Prior studies have suggested that men might have worse short-term outcomes, but limited data are available regarding long-term outcomes. We hypothesized that men, compared to women, with TC have worse short- and long-term outcomes. METHODS: A retrospective study of patients diagnosed with TC between 2005 and 2018 in the Veteran Affairs system was performed. Primary outcomes were in-hospital death, 30-day risk of stroke, death, and long-term mortality. RESULTS: A total of 641 patients were included (444 men [69%]; 197 women [31%]). Men had a higher median age (65 vs 60 years; P \u3c 0.001), and women were more likely to present with chest pain (68.7% vs 44.1%; P \u3c 0.001). Physical triggers were more common in men (68.7% vs 44.1%, P \u3c 0.001). Men had a higher in-hospital mortality rate (8.1% vs 1%; P \u3c 0.001). On multivariable regression analysis, female sex was an independent predictor for improved in-hospital mortality, compared to men (odds ratio 0.25, 95% confidence interval 0.06-1.10; P = 0.04). On 30-day follow-up, no difference occurred in a combined outcome of stroke and death (3.9% vs 1.5%; P = 0.12). On long-term follow-up (3.7 ± 3.1 years), female sex was identified as an independent predictor of lower mortality (hazard ratio 0.71, 95% CI 0.51-0.97; P = 0.032). Women were more likely to have TC recurrence (3.6% vs 1.1%; P = 0.04). CONCLUSIONS: In our study with a predominantly male population, men had less-favourable short- and long-term outcomes after TC, compared to those of women

Sex Differences in Stress-Induced (Takotsubo) Cardiomyopathy

Background: Takotsubo cardiomyopathy (TC) affects predominantly women. Prior studies have suggested that men might have worse short-term outcomes, but limited data are available regarding long-term outcomes. We hypothesized that men, compared to women, with TC have worse short- and long-term outcomes. Methods: A retrospective study of patients diagnosed with TC between 2005 and 2018 in the Veteran Affairs system was performed. Primary outcomes were in-hospital death, 30-day risk of stroke, death, and long-term mortality. Results: A total of 641 patients were included (444 men [69%]; 197 women [31%]). Men had a higher median age (65 vs 60 years; P \u3c 0.001), and women were more likely to present with chest pain (68.7% vs 44.1%; P \u3c 0.001). Physical triggers were more common in men (68.7% vs 44.1%, P \u3c 0.001). Men had a higher in-hospital mortality rate (8.1% vs 1%; P \u3c 0.001). On multivariable regression analysis, female sex was an independent predictor for improved in-hospital mortality, compared to men (odds ratio 0.25, 95% confidence interval 0.06-1.10; P = 0.04). On 30-day follow-up, no difference occurred in a combined outcome of stroke and death (3.9% vs 1.5%; P = 0.12). On long-term follow-up (3.7 ± 3.1 years), female sex was identified as an independent predictor of lower mortality (hazard ratio 0.71, 95% CI 0.51-0.97; P = 0.032). Women were more likely to have TC recurrence (3.6% vs 1.1%; P = 0.04). Conclusions: In our study with a predominantly male population, men had less-favourable short- and long-term outcomes after TC, compared to those of women

LONG TERM OUTCOMES OF TAKOTSUBO CARDIOMYOPATHY IN MEN COMPARED TO WOMEN IN THE US VETERAN AFFAIRS HEALTHCARE SYSTEM

Background: Takotsubo cardiomyopathy is characterized by significant transient left ventricular dysfunction. Differences in long term outcome in men compared to women is not well described in the literature. Methods: We performed a retrospective study using chart review for patients diagnosed with Takotsubo Cardiomyopathy between 2005 and 2018 in the Veteran Affairs (VA) national database. We included patients who met the Mayo Clinic diagnostic criteria for Takotsubo Cardiomyopathy. We compared the long term outcomes in men vs women patients. Results: 641 patients were included, of those 69.3% were males, median age was 64 years, median ejection fraction at the time of diagnosis was 35. On Kaplan-Meier analysis there was no significant difference between men and women in the rates of recurrence of Takotsubo at median follow up of 4 years, or arrhythmia at 1 year (Figure-1 A and B respectively). However, men had higher mortality rate over 10 year follow up period (Figure-1 C). Conclusion: In patients with Takotsubo cardiomyopathy at the VA system, men had higher mortality rates but there was not significant difference in rates of recurrence or arrhythmias when compared to women

Cryoballoon vs radiofrequency ablation of atrial fibrillation: insights from the Veterans Healthcare System

PURPOSE: Catheter ablation is considered the mainstay treatment for drug-refractory atrial fibrillation (AF). The aims of our study were to compare the efficacy and safety of the most two currently approved approaches (point-by-point radiofrequency ablation (RFA), either with contact force (CF) or without contact force (nCF) catheters, and cryoballoon ablation (CBA)) in the Veterans Healthcare System. METHODS: We performed a retrospective study of patients who underwent ablation for treatment of AF at the veterans affairs healthcare system between 2013 and 2018. Only the first reported ablation procedure was included. RESULTS: We included 956 patients in the study (97.4% males, 91.5% Caucasians, 67% paroxysmal AF), with 682 patients in RFA-nCF, 139 in RFA-CF, and 135 in CBA. Thirty-day complication rates were comparable between the three groups with the exception of higher incidence of phrenic nerve injury in CBA group when compared to RFA-nCF (2.2% vs 0.0%, p \u3c 0.01). Long-term recurrence rate of AF was significantly lower in the CBA group when compared to RFA-nCF (33.3% vs 47.7%, adjusted HR 0.60, 95% CI 0.44-0.83, p \u3c 0.01). On the other hand, it was similar between RFA-CF and RFA-nCF groups (43.9% vs 47.7%, adjusted HR 1.01, 95% CI 0.76-1.33, p 0.97). After stratifying patients based on AF type, these findings were only present in patients with paroxysmal AF. CONCLUSION: CBA for paroxysmal AF, in male dominant patients\u27 population, was associated with lower incidence of AF recurrence rate while having a comparable safety profile to RFA independent of the use of CF catheters

IVIG and under Burn Unit Care Yield Favorable Outcomes in Pediatric Patients with Toxic Epidermal Necrolysis: A Case Report and Literature Review

Body reactions to drugs can manifest as Stevens–Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN). TEN is the most severe form of cutaneous reactions with an incidence rate of 1-2 per million cases per year. Despite TEN being a critical and life-threatening condition, there is little to no evidence of clear management protocol. We reported a 5-year-old male child who presented with lamotrigine-induced TEN and was successfully treated with intravenous immune globulin (IVIG) with a burn unit care level, while TEN treatment with IVIG is an appropriate approach with predictable good outcomes, burn unit care is also effective in creating highly favorable effects. Upon reviewing the literature, several studies indicate that TEN patients treated with the combination of IVIG and burn unit care lead to decreased levels of morbidity and mortality than when treated with IVIG or burn unit care alone. Therefore, treatment involving both IVIG and burn unit care should be considered for TEN patients