The incidence of stress cardiomyopathy has increased during the COVID-19 pandemic, new findings suggest. Patients presenting with acute coronary syndrome (ACS) during the pandemic had a more than four-fold higher risk of being diagnosed with stress cardiomyopathy compared with those seen during non-pandemic periods, Dr. Ankur Kalra of Cleveland Clinic in Akron, Ohio, and colleagues report in JAMA Network Open. Some researchers have reported increases in stress cardiomyopathy, also known as Takotsubo syndrome, during the COVID-19 pandemic, the authors note. "This observation warrants further investigation to unravel a plausible pathogenic mechanism associated with COVID-19 causing Takotsubo syndrome-like cardiomyopathy vs a true increase in its incidence due to the associated psychological, social, and economic stress with imposed quarantine, lack of social interaction, strict physical distancing rules, and its economic consequences in people's lives," they add. The authors conducted a retrospective review of 1,914 patients with ACS who presented to cardiac catheterization labs at two hospitals. They compared the incidence of stress cardiomyopathy in patients presenting during four pre-pandemic control periods (March-April 2018, 390 patients; January-February 2019, 309 patients; March-April 2019, 679 patients; and January-February 2020, 278 patients) and during the pandemic (March-April 2020, 175 patients). The incidence of stress cardiomyopathy was 7.8% during COVID-19, versus 1.5%-1.8% during the control periods. The rate ratio for stress cardiomyopathy was 4.58 for patients treated during the pandemic compared to the control groups (P<0.001). None of the patients with stress cardiomyopathy during the pandemic had COVID-19. Patients with stress cardiomyopathy during the pandemic spent six to nine days in the hospital, on average, compared to three to four, three to six, four to eight or four to five days for stress cardiomyopathy patients during the control periods. However, the risks of mortality and rehospitalization were similar. "The association between stress cardiomyopathy and increasing levels of stress and anxiety has long been established. The psychological, social, and economic distress accompanying the pandemic, rather than direct viral involvement and sequelae of the infection, are more likely factors associated with the increase in stress cardiomyopathy cases," Dr. Kalra and colleagues write. "This was further supported by negative COVID-19 testing results in all patients diagnosed with stress cardiomyopathy in the study group." Dr. Kalra was not available for an interview by press time. —Reuters Staff Source
