Incidence, determinants and prognostic relevance of dyspnea at admission in patients with Takotsubo syndrome: results from the international multicenter GEIST registry

Abstract

pasquale caldarola 9 , Holger thiele 10 , ibrahim Akin 3 , natale Daniele Brunetti 11* , ingo eitel 2,12 & francesco Santoro 11,12 clinical presentation of takotsubo syndrome (ttS) may range from acute chest pain to dyspnea: the prognostic role of clinical onset is still controversial. Aim of this study was therefore to investigate the prognostic relevance of dyspnea at presentation in patients with TTS. We analyzed 1,071 TTS patients (median age 72 years, 90% female) enrolled in the international multicenter GEIST registry. patients were divided according to the presence or absence of dyspnea at hospital admission, as clinically assessed by the accepting physician. the primary endpoint was occurrence of in-hospital complications defined as a composite of pulmonary edema, cardiogenic shock and death. Overall, 316 (30%) patients presented with dyspnea at hospital admission. Diabetes, lower left ventricular ejection fraction and presence of pulmonary disease or atrial fibrillation were independently associated with dyspnea. In-hospital pulmonary edema, cardiogenic shock and death (17% vs. 3%, p < 0.001; 12% vs. 7%, p = 0.009; 5% vs. 2%, p = 0.004 respectively) and long-term overall mortality (22% vs. 11%, p < 0.001) occurred more frequently in patients with dyspnea than in those without. At multivariable analysis, dyspnea at presentation remained independently associated to both the composite primary endpoint [odds ratio 2.98 (95% confidence interval (CI) 1.95-4.59, p < 0.001] and all-cause mortality [hazard ratio 2.03 (95% CI 1.37-2.99), p < 0.001]. Dyspnea at presentation is common in TTS and is independently associated with in-hospital complications and impaired long-term prognosis. thorough

Takotsubo Syndrome—Is There a Need for CMR?

“…Subsuming the outlined potencies of CMR concerning functional changes in TTS-patients, we conclude the following: by performing bSSFP or FSE for cine imaging, [ 1 ] typical hypokinesia and RWMA can solidly be determined; [ 2 ] additional prognostic value of RVi and LA-EF can be generated and can reproducibly be measured; [ 3 ] life-threatening complications become obvious (e.g. LV thrombus) and can be easily detected during the acute CMR Scan; and [ 4 ] strain-analysis via FT is promising and may open new prognostic perspectives in TTS.…”

“…Aggregating the stated capabilities of CMR in tissue characterisation of TTS patients, we suggest [ 1 ] the constant usage of LGE with a high SI threshold of five SD for the exclusion of relevant myocardial necrosis, [ 2 ] the routine visualisation of oedema in the acute setting and [ 3 ] the liberal acquisition of mapping sequences for scientific reasons.…”

“…Takotsubo syndrome (TTS), which typically mimics acute coronary syndrome (ACS) with acute occurring symptoms such as angina pectoris or dyspnoea [ 1 , 2 ], new findings in the electrocardiogram (ECG) (e.g. pathologic ST-segment, T-waves or QTc-segments) [ 3 – 5 ] and biochemical rise in cardiac markers (troponin, brain natriuretic peptide) [ 6 , 7 ], was firstly described at the beginning of the 1990s in Japan and likewise later in Europe and worldwide [ 8 – 10 ].…”

Update of takotsubo syndrome in the era of COVID-19

“…Prevalence of apical, mid-ventricular (Fig. 4), basal, and focal types are 62-88%, 10-18.5%, 0-5.8%, and 0-6.1%, respectively [26][27][28][29][30][31]. Importantly, right ventricular wall motion could be involved with and without left ventricular wall motion abnormalities [6,26,27,32].…”

Current Knowledge and Future Challenges in Takotsubo Syndrome: Part 1—Pathophysiology and Diagnosis

“…Therefore, the GEIST prognostic score may be helpful in early risk stratification. In addition, a recently published analysis of the GEIST registry has revealed dyspnea at admission as an independent risk factor for in-hospital complications and poor long-term outcomes [ 35 ]. Thus, symptom evaluation including dyspnea may constitute a useful tool to enhance risk-stratification models for TTS patients [ 35 ].…”