Madhavan et al reported a simple risk score for predicting heart failure in patients with apical ballooning syndrome (takotsubo, stress cardiomyopathy). The authors are from the Mayo Clinic.
Patient selection: takotsubo/stress cardiomyopathy
Parameters:
(1) age in years
(2) physical stressor
(3) left ventricular ejection fraction in percent
Parameter
Finding
Points
age in years
<= 70 years
0
> 70 years
1
physical stressor
absent
0
present
1
LVEF in percent
>= 40%
0
< 40%
1
total score =
= SUM(points for all 3 parameters)
Interpretation:
• minimum score: 0
• maximum score: 3
• The higher the score the greater the risk for heart failure.
Score
Heart Failure
0
0-7%
1
17-28%
2
56%
3
62-85%
from Figure 1
Observations:
(1) inotropic agents should be used with caution
(2) early initiation of beta-adrenergic blockers may be harmful
(3) intra-aortic balloon pump may be preferred for severe hypotension or shock
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