J Korean Med Sci.  2012 Jan;27(1):52-57. 10.3346/jkms.2012.27.1.52.

APACHE II Score, Rather Than Cardiac Function, May Predict Poor Prognosis in Patients With Stress-Induced Cardiomyopathy

• Joe BH
• Jo U
• Kim HS
• Park CB
• Hwang HJ
• Sohn IS
• Jin ES
• Cho JM
• Park JH
• Kim CJ

• KMID: 1792979
• DOI: http://doi.org/10.3346/jkms.2012.27.1.52

Abstract

While the disease course of stress-induced cardiomyopathy (SIC) is usually benign, it can be fatal. The prognostic factors to predict poorer outcome are not well established, however. We analyzed the Acute Physiology And Chronic Health Evaluation (APACHE) II score to assess its value for predicting poor prognosis in patients with SIC. Thirty-seven consecutive patients with SIC were followed prospectively during their hospitalization. Clinical factors, including APACHE II score, coronary angiogram, echocardiography and cardiac enzymes at presentation were analyzed. Of the 37 patients, 27 patients (73%) were women. The mean age was 66.1 +/- 15.6 yr, and the most common presentation was chest pain (38%). Initial echocardiographic left ventricular ejection fraction (EF) was 42.5% +/- 9.3%, and the wall motion score index (WMSI) was 1.9 +/- 0.3. Six patients (16%) expired during the follow-up period of hospitalization. Based on the analysis of characteristics and clinical factors, the only predictable variable in prognosis was APACHE II score. The patients with APACHE II score greater than 20 had tendency to expire than the others (P = 0.001). Based on present study, APACHE II score more than 20, rather than cardiac function, is associated with mortality in patients with SIC.

Keyword

APACHE II Score; Cardiac Function; Stress-Induced Cardiomyopathy

MeSH Terms

*APACHE
Aged
Aged, 80 and over
Chest Pain/etiology
Echocardiography
Female
Humans
Kaplan-Meier Estimate
Male
Middle Aged
Predictive Value of Tests
Prognosis
Prospective Studies
ROC Curve
Takotsubo Cardiomyopathy/*diagnosis/mortality
Ventricular Function, Left

Figure

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  Fig. 1 ROC curve of APACHE II score in predicting death in patients with stress-induced cardiomyopathy.

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  Fig. 2 Kaplan-Meier survival curve shows significant difference in cumulative survival between two groups divided by APACHE II score 20.

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