Echocardiographic Correlates of Acute Heart Failure, Cardiogenic Shock, and In-Hospital Mortality in Tako-Tsubo Cardiomyopathy

Citro, Rodolfo; Rigo, Fausto; D’Andrea, Antonello; Ciampi, Quirino; Parodi, Guido; Provenza, Gennaro; Piccolo, Raffaele; Mirra, M.; Zito, Concetta; Giudice, Roberta; Patella, Marco Mariano; Antonini‐Canterin, Francesco; Bossone, Eduardo; Piscione, Federico; Salerno‐Uriarte, Jorge A.

doi:10.1016/j.jcmg.2013.09.020

Cited by 220 publications

(200 citation statements)

References 37 publications

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“…This type of TTC was first reported by Haghi et al in 2006 and the recognition of this pathophysiology became widely known (40). In a large series of patients with TTC in the Italian network, mid-ventricular and inverted TTC variants were detected in 18.1% and 4.8% of TTC patients, respectively (11). Although the causes of these differences are still controversial, there are tendencies towards patients with inverted TTC as follows: (I) younger than those with the other types of TTC (41); and (II) lower prevalence of dyspnea, pulmonary edema, cardiogenic shock, T-wave inversion, and acute reversible mitral regurgitation (11).…”

Section: Wall Motion and Systolic Functionmentioning

confidence: 86%

“…LV diastolic dysfunction of TTC evidenced by LV untwisting and increased E/e' ratio has recently been reported (11,45). E/e' ratio may be a simple and reproducible echocardiographic parameter for the assessment of LV filling pressure (11,28,(45)(46)(47)(48)(49).…”

Section: Diastolic Functionmentioning

confidence: 94%

“…Although the causes of these differences are still controversial, there are tendencies towards patients with inverted TTC as follows: (I) younger than those with the other types of TTC (41); and (II) lower prevalence of dyspnea, pulmonary edema, cardiogenic shock, T-wave inversion, and acute reversible mitral regurgitation (11). The assessment of LV ejection fraction (EF) is also important in the management of TTC because, according to the results of a large series of studies, LVEF and WMA are closely associated with major adverse events (11 …”

Section: Wall Motion and Systolic Functionmentioning

confidence: 99%

“…Meanwhile, according to the results of the earlier studies, 52% of the TTC patients have various complications (8)(9)(10)(11)(12)(13)(14); thus, TTC should be regarded as a more serious cardiovascular disease.…”

Section: Introductionmentioning

confidence: 99%

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Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Izumo¹,

Akashi²

2018

Cardiovasc. Diagn. Ther.

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Takotsubo cardiomyopathy (TTC) is newly-described secondary cardiomyopathy characterized by transient left ventricular (LV) dysfunction, which is increasingly recognized in the field of cardiology.TTC occurs in approximately 2% of the patients with acute coronary syndrome. Its onset is rare; however, its specific features play a crucial role in diagnosing the chest pain in clinical practice. TTC has generally favorable outcome with rapid recovery of LV function; however, an increasing evidence suggests that it should be regarded as a more serious acute cardiac disorder with a variety of complications. Owing to its widespread availability, even in emergency settings, transthoracic echocardiography plays a key role in the diagnostic assessment of TTC and contributes to an increased number of disease detection and incidence reports in contemporary clinical practice. This review focuses on the role of echocardiography in understanding the clinical prognostic implications in patients with TTC.

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Section: Wall Motion and Systolic Functionmentioning

confidence: 86%

Section: Diastolic Functionmentioning

confidence: 94%

Section: Wall Motion and Systolic Functionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

See 2 more Smart Citations

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Izumo¹,

Akashi²

2018

Cardiovasc. Diagn. Ther.

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“…However, patients are at risk for recurrence even years after the first event, and data on in-hospital and longterm outcomes are limited. [7][8][9][10] The potential role of catecholamine excess in the pathogenesis of takotsubo cardiomyopathy has been long debated, 11 and as such beta-blockers have been proposed as a therapeutic strategy. 12 Nevertheless, to our knowledge, no prospective trials evaluating the therapeutic management have been reported to date.…”

mentioning

confidence: 99%

Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy

Templin¹,

et al. 2015

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BACKGROUND The natural history, management, and outcome of takotsubo (stress) cardiomyopathy are incompletely understood. METHODS The International Takotsubo Registry, a consortium of 26 centers in Europe and the United States, was established to investigate clinical features, prognostic predictors, and outcome of takotsubo cardiomyopathy. Patients were compared with age-and sex-matched patients who had an acute coronary syndrome. RESULTS Of 1750 patients with takotsubo cardiomyopathy, 89.8% were women (mean age, 66.8 years). Emotional triggers were not as common as physical triggers (27.7% vs. 36.0%), and 28.5% of patients had no evident trigger. Among patients with takotsubo cardiomyopathy, as compared with an acute coronary syndrome, rates of neurologic or psychiatric disorders were higher (55.8% vs. 25.7%) and the mean left ventricular ejection fraction was markedly lower (40.7±11.2% vs. 51.5±12.3%) (P<0.001 for both comparisons). Rates of severe in-hospital complications including shock and death were similar in the two groups (P=0.93). Physical triggers, acute neurologic or psychiatric diseases, high troponin levels, and a low ejection fraction on admission were independent predictors for in-hospital complications. During long-term follow-up, the rate of major adverse cardiac and cerebrovascular events was 9.9% per patient-year, and the rate of death was 5.6% per patient-year. CONCLUSIONS Patients with takotsubo cardiomyopathy had a higher prevalence of neurologic or psychiatric disorders than did those with an acute coronary syndrome. This condition represents an acute heart failure syndrome with substantial morbidity and mortality. (Funded by the Mach-Gaensslen Foundation and others; ClinicalTrials.gov number, NCT01947621.).

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Assessment of the German and Italian Stress Cardiomyopathy Score for Risk Stratification for In-hospital Complications in Patients With Takotsubo Syndrome

et al. 2019

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IMPORTANCE Takotsubo syndrome (TTS) is an acute, reversible heart failure syndrome featured by significant rates of in-hospital complications. There is a lack of data for risk stratification during hospitalization.OBJECTIVE To derive a simple clinical score for risk prediction of in-hospital complications among patients with TTS. DESIGN, SETTING, AND PARTICIPANTSIn this prognostic study, 1007 consecutive patients were enrolled in the German and Italian Stress Cardiomyopathy (GEIST) registry from July 1, 2007, through December 31, 2017, and identified as the derivation cohort; 946 patients were enrolled in the Spanish Registry for Takotsubo Cardiomyopathy (RETAKO) as the external score validation. An admission risk score was developed using a stepwise multivariable regression analysis from 2 registries. Data analysis was performed from March 1, 2018, through July 31, 2018. MAIN OUTCOMES AND MEASURESIn-hospital complications were defined as death, pulmonary edema, need for invasive ventilation, and cardiogenic shock. Four variables were identified as independent predictors of in-hospital complications and were used for the score: male sex, history of neurologic disorder, right ventricular involvement, and left ventricular ejection fraction (LVEF). RESULTSOf the 1007 patients enrolled in the GEIST registry, 107 (10.6%) were male, with mean (SD) age of 69.8 (11.4) years. Overall rate of in-hospital complications was 23.3% (235 of 1007) (death, 4.0%; pulmonary edema, 5.8%; invasive ventilation, 6.4%; and cardiogenic shock, 9.1%). The GEIST prognosis score was derived by providing 20 points each for male sex and history of neurologic disorders and 30 points for right ventricular involvement and then subtracting the value in percent of LVEF (decimal values between 0.15 and 0.70). Score accuracy on area under the receiver operating characteristic curve analysis was 0.71, with a negative predictive power of 87% with scores less than 20. External validation in the RETAKO population (124 [13.1%] male; mean [SD] age, 69.5 [14.9] years) revealed an area under the curve of 0.73 (P = .46 vs GEIST xderivation cohort). Stratification into 3 risk groups (<20, 20-40, and >40 points) classified 316 patients (40.9%) as having low risk; 342 (44.3%) as having intermediate risk, and 114 (14.8%) as having high risk of complications. The observed in-hospital complication rates were 12.7% for low-risk patients, 23.4% for intermediate-risk patients, and 58.8% for high-risk patients (P< .001 for trend). After 2.6 years of follow-up, patients with in-hospital complications had significantly higher rates of mortality than those without complications (40% vs 10%, P = .01). CONCLUSIONS AND RELEVANCEThe GEIST prognostic score may be useful in early risk stratification for TTS. High-risk patients with TTS may require an intensive care unit stay, and low-risk patients with TTS could be discharged within a few days. In-hospital complications in patients with TTS may be associated with increased risk of long-term mortality.

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Echocardiographic Correlates of Acute Heart Failure, Cardiogenic Shock, and In-Hospital Mortality in Tako-Tsubo Cardiomyopathy

Cited by 220 publications

References 37 publications

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy

Assessment of the German and Italian Stress Cardiomyopathy Score for Risk Stratification for In-hospital Complications in Patients With Takotsubo Syndrome

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