Incomplete Recovery From Takotsubo Syndrome Is a Major Determinant of Cardiovascular Mortality

Abstract

Background: Although there is an apparent rapid and spontaneous recovery of left ventricular ejection fraction (LVEF) in patients with Takotsubo syndrome (TTS), recent studies have demonstrated a long-lasting functional impairment in those patients. The present study sought to evaluate the predictors of incomplete recovery following TTS and its impact on cardiovascular mortality. Methods and Results:Patients with TTS between 2008 and 2018 were retrospectively enrolled at 3 different institutions. After exclusion of in-hospital deaths, 407 patients were split into 2 subgroups according to whether their LVEF was >50% (recovery group; n=341), or ≤50% (incomplete recovery group; n=66) at the chronic phase. Multivariate logistic regression analysis found that LVEF (odds ratio [OR]: 0.94; 95% confidence interval [CI]: 0.91-0.98; P<0.001) and C-reactive protein levels (OR: 1.11; 95% CI: 1.02-1.22; P=0.02) at discharge were independent predictors of incomplete recovery. At a median follow up of 52 days, a higher cardiovascular mortality was evident in the incomplete recovery group (16% vs. 0.6%; P<0.001). Conclusions:This study demonstrated that incomplete recovery after TTS is characterized by residual systemic inflammation and an increased cardiac mortality at follow up. Altogether, the present study findings determined that patients with persistent inflammation are a high-risk subgroup, and should be targeted in future clinical trials with specific therapies to attenuate inflammation.

Optimal Heart Failure Medical Therapy and Mortality in Survivors of Cardiogenic Shock: Insights From the FRENSHOCK Registry

“…Although an improvement of LVEF after CS can be observed in a considerable number of patients following coronary revascularization, recovery from severe inflammation, volume optimization, and introduction of HF drugs, adverse clinical events may occur as a consequence of adverse cardiac remodeling, residual ischemia, incomplete LVEF recovery, or progression of the baseline diseases, 6 , 24 , 25 , 26 which all can be targeted by beta blockers, RASI, and MRA, which compose the triple GDMT. 6 , 24 , 27 Although there has been no randomized clinical trial that investigated the effects of HF drugs at the recovery phase of patients with CS, the recent STRONG‐HF (Safety, Tolerability and Efficacy of Rapid Optimization, Helped by NT‐proBNP Testing, of Heart Failure Therapies) trial demonstrated that rapid titration of GDMT using beta blockers, RASI, and MRA reduced the risk of 180‐day all‐cause death or HF hospitalization in patients with acute HF without shock.…”

Time Course of Left Ventricular Strain Assessment via Cardiovascular Magnetic Resonance Myocardial Feature Tracking in Takotsubo Syndrome

“…In a recent cohort studied, the average LVEF improved from 41.1% to 59.9% within 2 months [ 11 ]. However, recent studies have reported incomplete LVEF recovery from TTS, characterized by residual systemic inflammation and increased cardiac mortality at follow-up [ 18 ]. The recovery time for TTS patients is also clinically important.…”

Inflammatory Forms of Cardiomyocyte Cell Death in the Rat Model of Isoprenaline-Induced Takotsubo Syndrome

“…The increased level of proinflammatory cytokines persists for several months after the onset of TTS symptoms, which suggests a low-grade chronic inflammatory state [18]. Moreover, residual high systemic inflammation, defined as increased levels of C-reactive protein at discharge, is a predictor of incomplete recovery after the acute phase of TTS and is an independent factor of cardiovascular events [20,28]. Recently, it has been shown that patients with TTS have higher ultra-small iron oxide superparamagnetic particle (USPIO) retention in the LV during the acute phase, regardless of the ballooning or non-ballooning segment, when compared with the control group.…”