Association Between Mortality and Left Ventricular Ejection Fraction in Patients With Takotsubo Syndrome Versus Acute Coronary Syndrome

Abstract

Background/Aim: The association between ejection fraction (EF) and mortality in TTS patients as compared to ACS is limited. This study aims to investigate the association between EF and clinical outcomes in patients with TTS as compared to ACS. Patients and Methods: This study compared in-hospital, and long-term incidence of clinical outcomes for 5 years in patients with TTS and ACS. The study was composed of two groups EF≥35% and EF<35%. Results: The long-term mortality of the EF≥35% for 5 years was significantly higher in TTS patients as compared to ACS (18.1% vs. 7.7%, p<0.01). Irrespective of EF, a non-cardiovascular death was significantly higher in TTS as compared to ACS patients with EF≥35 (6.4% vs. 2.1%; p=0.02) and with EF<35% (21.4% vs. 7.5%; p=0.03). Conclusion: The long-term mortality is significantly higher in TTS as compared to ACS dominated by a non-cardiovascular cause of death at 5years-follow-up.The Takotsubo Syndrome (TTS) is generally accepted as a malignancy (1, 2). The initial appearance of TTS resembles acute coronary syndrome (ACS), where the acute deterioration of the left ventricular (LV) systolic function can lead to severe complications, including congestive heart failure, thromboembolic events, cardiogenic shock and lethal arrhythmias, as well as an in-hospital mortality of 2.0%-8.7% for both conditions (2-7).A transient reduced LV ejection fraction (EF) is a known phenomenon in patients with TTS. Admittedly, the range of EF has been estimated to be lower in patients with TTS compared to ACS at time of event (2, 3). In-hospital and adverse cardiac events during long-term follow-up are higher in TTS patients with EF<35% as compared to patients with EF≥35% (8-12). Data on in-hospital and long-term outcomes comparing EF grade between TTS and ACS patients are limited (3,13,14).This study sought to compare in-hospital and long-term mortality in patients with TTS versus ACS depending on EF. Moreover, predictors of mortality were evaluated. Patients and MethodsA total of 648 patients presenting with TTS and ACS were included in the study retrospectively. TTS was defined by the Mayo clinic criteria (15). To evaluate the diagnosis of TTS, the electrocardiograms (ECGs), echocardiograms and angiograms were inspected by two independent experienced cardiologists. Other possible differential diagnoses as valvular disease, myocarditis, coronary spasm or chemotherapy-related cardiac dysfunction were excluded. Data of patients who were suffering from ACS between 2007 and 2008 (non-ST-elevation or ST-elevation myocardial infarction or unstable angina (NSTEMI or STEMI or UA)) in the Clinic for Cardiology, University Hospital Mannheim, and afterwards underwent treatment with percutaneous coronary intervention (PCI) involving a stent implantation, were examined and assessed using the department's database. The study was composed of two groups. The first group had an EF≥35% and consisted of 94 patients with TTS and 432 patients with ACS (241 NSTEMI, 185 STEMI, 6 UA). The second group (EF<35%) include...

Analysis of 9 Cases of Takotsubo Syndrome and an Analysis of the Clinical Characteristics of Takotsubo Syndrome From a Chinese Population

“…Citro et al ( 30 ) found that patients in the LVEF ≤35 group were older than those in the LVEF >35 group and were more likely to have adverse cardiovascular events. Abumayyaleh et al ( 31 ) found that after 5 years of follow-up, the long-term mortality of TTS patients was significantly higher than that of ACS patients. In a study of abnormal left ventricular wall motion and coronary artery flow, it was found that during the acute phase of TTS, the myocardial blood flow of the dysfunctional left ventricular segment was lower than that of the normal ventricular wall motion ( 32 , 33 ).…”

TakoTsubo Syndrome: A Well-Known Disease but Not Everything Is Clear Yet

“…Cardiogenic shock precipitates the acute disease in approximately 20% of TTS and 6–10% of STEMI [ 4 , 48 ]. There is no unanimous consensus about the best strategy to treat cardiogenic shock in TTS, but previous studies showed that TTS patients are more likely to require mechanical respiratory support than ACS [ 49 ]. Notwithstanding, the mortality rate is substantially higher among cardiogenic shock due to STEMI ( 50%) vs TTS (15%) [ 39 , 50 ].…”