Takotsubo cardiomyopathy, sepsis and clinical outcome: does gender matter?

Infections and sepsis are important causes of cardiomyopathy, since they can affect ventricular function, systolic blood pressure, circulating volume and vessel tone, and so increasing mortality rate. Among cardiomyopathies, Takotsubo cardiomyopathy (TTC) represents an uncommon clinical condition characterized by a clinical picture similar to that of acute myocardial infarction. We sought to investigate across the available literature the possible difference by gender of mortality in TTC patients with sepsis. We systematically explored PubMed to identify case reports and case series reporting the possible association between sepsis and TTC. Out of a total of 2340 articles found under the term Takotsubo cardiomyopathy, we extracted 38 papers reporting the association between TTC and sepsis. Among these, 12 were case reports (13 cases), with an expected higher prevalence of women (n= 10/13, 76.9 %). The mean age was 57.513.6 years, and bacterial infections were more frequent (n= 11/13, 84.6%). In 7 cases (53.8%) there was the culture-based definition of the microrganism: bacterial (5/7, 71.4%), viral (1/7, 14.3%), and protozoan (1/7, 14.3%). Clinical outcome was favorable in most cases (12/13, 92.3%) of cases, and discharge occurred after a few days. As for case series, we identified two suitable studies, performed in the United States and in Japan. Alhough TTC mostly affects women, males are exposed to a worst clinical outcome and higher IHM in the presence of sepsis. Since their presentation to the ED, male patients suspected for TTC should be carefully protected against infectious complications, since the onset of sepsis could be more harmful and life-threatening.