***TASK*** the task is to summarize an input biomedical literature in six sentences 
    ***INPUT*** the input is a biomedical literature 
    ***OUTPUT*** the output is the summary of an input biomedical literature in six sentences 
    ***DOCUMENTATION*** 
    ***EXAMPLES*** 
    Input: OBJECTIVES This study was design ed to define more completely the clinical spectrum and consequences of stress cardiomyopathy ( SC ) beyond the acute event . BACKGROUND Stress cardiomyopathy is a recently recognized condition characterized by transient cardiac dysfunction with ventricular ballooning . METHODS Clinical profile and outcome were prospect ively assessed in 136 consecutive SC patients . RESULTS Patients were predominantly women ( n = 130 ; 96 % ) , but 6 were men ( 4 % ) . Ages were 32 to 94 years ( mean age 68 + /- 13 years ) ; 13 ( 10 % ) were < or=50 years of age . In 121 patients ( 89 % ) , SC was precipitated by intensely stressful emotional ( n = 64 ) or physical ( n = 57 ) events , including 22 associated with sympathomimetic drugs or medical/surgical procedures ; 15 other patients ( 11 % ) had no evident stress trigger . Twenty-five patients ( 18 % ) were taking beta-blockers  at the time of SC events . Three diverse ventricular contraction patterns were defined by cardiovascular magnetic resonance ( CMR ) imaging , usually with rapid return to normal systolic function , although delayed > 2 months in 5 % . Right and /or left ventricular thrombi were identified in 5 patients ( predominantly by CMR imaging ) , including 2 with embolic events . Three patients ( 2 % ) died in-hospital and 116 ( 85 % ) have survived , including 5 % with nonfatal recurrent SC events . All-cause mortality during follow-up exceeded a matched general population ( p = 0.016 ) with most deaths occurring in the first year . CONCLUSIONS In this large SC cohort , the clinical spectrum was heterogeneous with about one-third either male , < or=50 years of age , without a stress trigger , or with in-hospital death , nonfatal recurrence , embolic stroke , or delayed normalization of ejection fraction .  Beta-blocking drugs were not absolutely protective and SC was a marker for increased noncardiac mortality . These data support exp and ed management and surveillance strategies including CMR imaging and consideration for anticoagulation OBJECTIVE To compare left ventricular ( LV ) systolic and diastolic function in patients with apical ballooning syndrome ( ABS ) and those with acute myocardial infa rct ion ( AMI ) using 2-dimensional Doppler echocardiography and strain rate imaging ( SRI ) . PATIENTS AND METHODS We prospect ively enrolled patients with newly diagnosed AMI and ABS who had akinetic apical walls . Both 2-dimensional Doppler echocardiography and SRI were performed on hospital day 1 or within 24 hours of primary percutaneous coronary intervention . RESULTS Twenty-four patients with AMI and 13 patients with ABS ( mean + /- SD age , 63+/-15 vs 73+/-12 years ; P=.03 ) were prospect ively enrolled in the study from October 3 , 2005 through July 12 , 2006 . The mean + /- SD LV end-diastolic volume was larger ( 58.1+/-9.1 vs 45.2+/-10.6 mL/m(2 ) ; P<.001 ) and the mean + /- SD LV ejection fraction was lower ( 35%+/-6 % vs 43%+/-9 % ; P=.006 ) in patients with ABS compared with patients with AMI . The early diastolic mitral annular velocity was similar ( 0.06+/-0.02 vs 0.06+/-0.02 m/s ; P=.85 ) in both groups , but the ratio of early diastolic mitral valve inflow velocity to early diastolic mitral annulus velocity was higher in patients with AMI than in patients with ABS ( 16.3+/-6.9 vs 12.2+/-3.2 ; P=.05 ) . The systolic strain rate was decreased at the apex in both groups ( P=.98 ) . Both the early diastolic strain rate of the apex ( 0.64+/-0.24 vs 0.48+/-0.30 s(-1 ) ; P=.04 ) and the postsystolic shortening index of the apex ( 61%+/-15 % vs 45%+/-23 % ; P=.006 ) were higher in the patients with ABS than in those with AMI . However , early diastolic SR was higher in the akinetic apical walls of patients with AMI with recovery than those with no recovery ( 0.64+/-0.35 vs 0.43+/-0.25 s(-1 ) ; P=.04 ) and was similar between akinetic apical walls of patients with AMI with recovery and the akinetic apical walls of ABS . CONCLUSION Compared with patients with AMI , those with ABS showed the functional paradox of worse initial LV systolic function with larger LV size but better LV diastolic function . The early systolic strain rate and postsystolic shortening were greater in patients with ABS than in those with AMI ; hence , these measurements can be helpful in distinguishing ABS from AMI and in detecting myocardial viability Objectives : To determine the incidence , clinical characteristics , and the coronary angiographic features of patients with apical ballooning syndrome ( ABS ) among those recruited into a large , prospect i ve , international , multicenter trial . Background : ABS is an important entity in the differential diagnosis of ST‐elevation myocardial infa rct ion ( STEMI ) . Current data regarding ABS are limited to single center registries . Methods : Patients with ABS were identified , based on the Mayo Clinic diagnostic criteria , from those enrolled into the HORIZONS‐AMI trial .  Quantitative angiography was performed by a core laboratory to identify the frequency and severity of coronary artery disease . Results : Among the 2,648 patients who had left ventriculography in addition to coronary angiography , 12 patients were identified with ABS . All patients were female and they were compared to the remaining 571 female patients with STEMI . Compared with patients with STEMI ( 97.9 % of our cohort ) , patients with ABS ( 2.1 % ) had a lower prevalence ( 42 % vs. 100 % , P < 0.05 ) and severity ( number of plaques measuring > 30 % diameter stenosis per patient : 0.58 ± 0.90 vs. 4.13 ± 2.68 , P < 0.0001 ) of coronary artery disease . There were no in‐hospital deaths or major adverse cardiovascular events ( MACE ) in the ABS group vs. 2.1 % and 3.7 % respectively in the STEMI group , nor at 2‐year follow up ( death : 0 % vs. 5.5 % , MACE : 0 % vs. 19.4 % ) , but these differences were not statistically significant . Conclusions : In HORIZONS‐AMI , ABS was identified exclusively in women ( 2.1 % of female patients , 0.5 % of all patients ) and MACE were absent in this uncommon but important group of patients . Coronary artery disease was often present in patients with ABS , but its prevalence and severity was significantly less compared with STEMI patients . © 2011 Wiley Periodicals , AIMS Typical tako-tsubo cardiomyopathy ( TTC ) mimics acute anterior myocardial infa rct ion ( AMI ) and the differential diagnosis is challenging before coronary angiography ( CA ) is performed ; it demonstrates reduced or absent ante grade flow in the left anterior descending artery ( LAD ) in AMI , whereas there is no such flow limiting in TTC . At the acute phase , we tested the usefulness of the distal LAD flow visualization by transthoracic Doppler echocardiography ( TDE ) to distinguish between these two diseases . For this purpose , we prospect ively enrolled 28 consecutive patients with TTC ( 75 ± 10 years , 93 % females ) who were compared with 28 consecutive patients with AMI treated successfully by primary angioplasty ( 66 ± 12 years , 79 % females ) . All the patients underwent the assessment of the distal LAD flow just before CA , using colour and pulsed-wave TDE . In addition , the symmetric involvement of wall motion abnormalities ( WMAs ) based on the extent of the disease far beyond one coronary territory in TTC was search ed by TDE . Non-invasive coronary flow reserve ( CFR ) by TDE , in the distal LAD , was also performed within 1 day after admission . RESULTS Before CA , the distal LAD flow was visible in 38 of 56 cases ( 68 % ) in the whole population , in all cases with TTC and in 10 cases with AMI ( 36 % ) . The sensitivity ( Se ) and specificity ( Sp ) of the LAD flow visualization for the diagnosis of TTC were 100 and 64 % , respectively , with a diagnostic accuracy of 82 % . In comparison , the pattern of WMA yielded a Se of 75 % and Sp of 86 % , and a diagnostic accuracy of 80 % . With the combination of both tools , the Se and Sp to detect TTC were 75 and 96 % respectively , with a diagnostic accuracy of 86 % . After CA , the acute CFR was less severely impaired in the TTC group when compared with the AMI group ( 2.2 ± 0.5 vs. 1.7 ± 0.6 , P < 0.01 ) despite a worse LV systolic dysfunction . CONCLUSION Non-invasive evaluation of the distal LAD flow could be helpful to differentiate TTC from AMI , and its combination with the pattern of WMA improved slightly its diagnostic accuracy . Furthermore , the acute CFR is less severely impaired in TTC compared with AMI despite poorer LV systolic dysfunction , suggesting that other mechanisms than direct microcirculatory damage are also involved in the pathogenesis of WMAs in TTC BACKGROUND Although the relationship between malignancies and catecholamine-induced myocardial stunning remains largely speculative , it has been suggested that the presence of cancer may lower the threshold for stress stimuli and /or may aggravate cardiac adrenoreceptor sensitivity . We sought to investigate whether associations exist between a previous or current diagnosis of malignancy , diagnostic parameters during hospitalization and death in takotsubo . METHODS AND RESULTS The 154 takotsubo patients were retrospectively identified between May 2008 and December 2014 . Previous history of malignancy was identified in 44 patients ( 28.5 % ) . Cardiac arrest was present at admission in 13 patients ( 8.4 % ) . Intra-aortic balloon pump was inserted in 16 patients ( 10.4 % ) . In patients with malignancy , higher B-type natriuretic peptide ( BNP ) , leukocyte and C-reactive protein ( CRP ) peaks could be observed during the hospital phase . Initial impairment of left ventricular ejection fraction was negatively related to BNP , leukocyte , and CRP peaks . At a median follow-up of 364 days , all-cause death occurred in 41 patients ( 26.6 % ) and cardiac death in 12 patients ( 7.7 % ) . Multivariate Cox regression analysis identified malignancy ( hazard ratio 4.77 ( 1.02 - 22.17 ) , leukocyte peak and age as independent predictors of cardiac death . Malignancy ( 2.62 ( 1.26 - 5.44 ) , leukocyte peak ( 1.05 ( 1.01 - 1.08 ) and initial cardiac arrest ( 6.68 ( 2.47 - 18.01 ) were identified as independent predictors of overall mortality . CONCLUSIONS In the present takotsubo patients , the prevalence of malignancy was high and may have affected cardiovascular outcomes through the activation of inflammatory and neurohormonal mechanisms . ( Circ J 2016 ; 80 : 2192 - 2198 ) Objective Takotsubo syndrome ( TS ) mimics acute coronary syndrome ( ACS ) but has a distinct pathophysiology . While in-hospital adverse outcomes appear similar to those presenting with an ACS , data on longer term postdischarge risk are conflicting . This study sought to assess the long-term prognosis of patients discharged alive after TS . Methods The clinical profile and in-hospital and long-term outcomes were prospect ively assessed in consecutive patients with TS . Survival in patients with TS was compared with two representative age-matched and gender-matched comparison cohorts : a hospitalised ACS cohort and a community cohort without known cardiovascular disease ( CVD ) . Results Two hundred and -twenty-five patients with TS ( 216 women , mean age 63.7±11.8 years ) were included . In-hospital mortality was 1.8 % and 1.9 % for patients with TS and ACS , respectively . Of the 219 patients with TS with postdischarge follow-up , at a mean follow-up of 4.8±3.2 years , there were 19 ( 8.3 % ) deaths , 18 of which were from non-cardiac causes . When compared with the cohort without prior CVD , postdischarge patients with TS were at increased mortality risk ( HR 2.00 , 95 % CI 1.26 to 3.17 , p=0.003 ) , but mortality in postdisch 
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In conclusion , TTS has significantly different clinical characteristics than ACS .
However , the in-hospital and long-term overall mortality rates are not trivial for TTS patients , and some presenting features ( underlying diseases , male sex , advanced age , low LVEF and shock ) were significantly associated with all-cause mortality