Background/Purpose:

Takotsubo cardiomyopathy (TCM) or stress cardiomyopathy is an unusual but potentially fatal type of acute cardiomyopathy characterized by transient regional left ventricular systolic dysfunction. It is suggested to be related to stress-induced catecholamine release and is more common in females. Fibromyalgia is also characterized by chronic pain believed to be related to chronic emotional and physical stress. The aim of this study is to determine whether the prevalence of patients with FM is higher among patients hospitalized with TCM compared to the estimated prevalence of FM in the general population and to investigate the characteristics and outcomes of patients hospitalized with TCM and FM compared to patients with TCM and no FM.

Methods:

We used data from the National Inpatient Sample (NIS) for hospitalizations during the period 2005-2015 with TCM as a primary diagnosis and FM as a secondary diagnosis using ICD-9 codes. The proportion who met ACR classification criteria cannot be determined with the NIS database. We calculated the prevalence of FM in TCM hospitalizations and compared the characteristics and outcomes of TCM hospitalizations with FM and without FM using SPSS software. The prevalence of FM in the general adult population was obtained from Centers for Disease Control and Prevention (CDC) and is about 2%.

Results:

We identified a total of 8,164 TCM hospitalizations from 2005-2015 of which 238 (2.9%) had a diagnosis of FM.

FM hospitalizations with TCM were younger (63.0 vs 66. 2; p<0.01) and with a higher proportion of females (99.6% vs. 91.5%; p<0.01) compared to patients without FM. Common comorbidities and cardiovascular risk factors such as DM, HTN, and tobacco use were similar in both groups, however, obesity was more common in patients with FM (12.6% vs 9.0%; p=0.05).

Patients with TCM and FM also had higher rates of depression and drug use compared to those without FM. The rates of severe inpatient complications including cardiac shock and cardiac arrest were similar in both groups. One patient died in the FM group (0.4%) while 105 patients (1.3%) died in the non-FM group (p=0.2). The findings are summarized in the table.

Conclusion:

About 3 percent of TCM hospitalizations have FM. This is slightly higher than the estimated national prevalence of this disorder in the general population by the CDC. Patients with FM presenting with TCM are younger with even higher proportion of females compared to the ones without FM. Inpatient mortality due to TCM, however, was not statistically different between two groups.

Given the similar presumed etiologies in these disorders, this study suggests that FM may be a risk factor for TCM, however, further investigations are required to establish the possible association between FM and TCM.