The rate of stress cardiomyopathy, also known as takotsubo syndrome, was shown to be higher during the current COVID-19 pandemic than in earlier times, according to a study that was published Thursday. Ahmad Jabri, MD and colleagues, from Cleveland Clinic, reported these results in a manuscript published online in JAMA Network Open. During the pandemic, an increase in takotsubo syndrome cases, a stress cardiomyopathy, has been reported. However, it is unclear whether this is a rise in the actual syndrome rates possibly secondary to different stressors accompanying this pandemic, or rather symptoms that are mimicking the takotsubo syndrome. In this study, the authors compared the incidence of takotsubo during the COVID-19 pandemic to its incidence on similar dates in the past as well as outcomes and the relation of the syndrome to infection with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Jabri and colleagues retrospectively collected and analyzed data on 1914 patients admitted for acute coronary syndrome. Of these, 1656 were admitted in the months leading up to the pandemic and during the same months as the pandemic but in earlier years. This earlier period accounted for March-April 2018, two time periods in 2019 (January-February and March-April), and one in 2020 (January-February). The remainder (258 patients) were admitted the pandemic (March-April 2020). All patients were from two centers in the Cleveland Clinic health system in northeast Ohio. Neither median age nor sex was significantly different between the two period groups. The most common comorbid condition was hypertension in all groups, and COVID-19-period patients had a higher rate of hypertension than patients from earlier periods (March-April 2018: 349 patients [89.5%]; January-February 2019: 259 patients [83.8%]; March-April 2019: 524 patients [77.2%]; January-February 2020: 229 patients [82.4%]; COVID-19 period: 232 patients [89.9%]; p<0.001). In addition, pandemic-period patients had lower initial and peak troponin levels. During the COVID-19 period, the two hospitals saw significantly more cases of takotsubo (20) than in the pre-COVID periods (range, 5-12), with a rate ratio between the periods of 4.58 (95% confidence interval [CI], 4.11-5.11; p<0.001). Lab results showed that none of the patients from the pandemic period tested positive for the reverse transcription-polymerase chain reaction (RT-PCR) of COVID-19. There were longer hospital stays in patients admitted for takotsubo syndrome during the pandemic period than those without this diagnosis during the COVID-19 period. Mortality was not different between the periods. The study was limited by its design, as it included only patients from northeast Ohio and may not be generalizable to other states or countries. Some confounders such as temporal or regional differences cannot be accounted for. It is possible that the number of patients is underestimated during the COVID-19 period, as people avoided coming to the hospital. Although none of the patients in the COVID-19 period had infection-related symptoms, the test that was used had a sensitivity of 79%, so there could have been patients with false-negative test results. This retrospective study found that there was a higher incidence of takotsubo syndrome during the COVID-19 pandemic, with none of the patients having the virus on RT-PCR testing. The authors conclude that these findings may suggest an “indirect, psychological, social, and economic pandemic-related stress mechanism behind the disease process.” Source: Jabri A, Kalra A, Kumar A, et al. Incidence of Stress Cardiomyopathy During the Coronavirus Disease 2019 Pandemic. JAMA Netw Open 2020 Jul 9. https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2768093