Background/Purpose: Stress-induced cardiomyopathy (SIC), also known as Takotsubo cardiomyopathy (TCM), is characterized by acute left ventricular dysfunction, often triggered by emotional or physical stress. In recent years, SIC has been increasingly recognized in patients with underlying systemic inflammatory disorders. Systemic sclerosis (SSc), a chronic autoimmune disease, is known to affect the heart through mechanisms such as myocardial fibrosis and arrhythmias. However, data on the intersection of SIC and SSc are limited, and the clinical outcomes of this rare overlap remain poorly defined.

Methods: We conducted a retrospective analysis of the National Inpatient Sample (2017–2022), identifying adult hospitalizations with a primary diagnosis of stress-induced cardiomyopathy. We initially evaluated several autoimmune diseases for their association with clinical outcomes; systemic sclerosis showed a potentially important association, justifying further evaluation. Patients were then stratified into two groups: those with and without coexisting systemic sclerosis. Outcomes included in-hospital mortality, length of stay, and total hospital charges. Survey-weighted logistic and linear regression models were used to assess associations, adjusting for demographics, comorbidities, and hospital characteristics. Firth logistic regression was employed to address rare-event bias in mortality analyses.

Results: Among 51,415 patients hospitalized with stress-induced cardiomyopathy, only ~70 (0.14%) had a comorbid diagnosis of systemic sclerosis, highlighting the rarity of this overlap. Patients with SSc were predominantly female (100% vs. 89.6%, p = 0.20), more likely to be Black (35.7% vs. 6.0%, p < 0.001), and had a higher comorbidity burden (Charlson category 3: 71.4% vs. 28.3%, p = 0.004). There was no significant difference in mean age (66.8 vs. 67.3 years, p = 0.82). In adjusted logistic regression, SSc was independently associated with increased odds of in-hospital mortality (OR 7.39, 95% CI: 1.54–35.56, p = 0.013). These findings were consistent in Firth logistic regression (OR 8.61, 95% CI: 1.92–38.58, p = 0.005), reinforcing the robustness of the association. Patients with SSc also had a longer mean LOS (6.29 vs. 3.61 days; 95% CI: 2.18–10.39 vs. 3.52–3.69) and higher mean hospital charges ($77,652 vs. $58,425; 95% CI: $40,356–$114,948 vs. $56,444–$60,407). Although unadjusted comparisons showed higher LOS and charges in the SSc group, these differences were not statistically significant in adjusted models (LOS β = 2.13, p = 0.322).

Conclusion: Systemic sclerosis was associated with significantly higher in-hospital mortality among patients with stress-induced cardiomyopathy (Takotsubo cardiomyopathy), despite its rarity. Both survey-weighted and Firth logistic regression analyses consistently demonstrated this association, reinforcing the robustness of the findings and minimizing the influence of confounding and small-sample bias. These results highlight a clinically vulnerable subgroup that warrants closer monitoring. This rare overlap warrants further prospective studies to elucidate underlying immunologic mechanisms and enhance risk stratification.

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ACR Meeting Abstracts - https://acrabstracts.org/abstract/unmasking-mortality-risk-the-impact-of-systemic-sclerosis-in-stress-induced-cardiomyopathy/