Long‐term outcome in patients with Takotsubo syndrome presenting with severely reduced left ventricular ejection fraction

Abstract

AimTo evaluate the long-term outcome of patients with Takotsubo syndrome (TTS) and severely reduced left ventricular ejection fraction (LVEF ≤ The study population included 326 patients (mean age 69.5 ± 10.7 years, 28 male) with TTS enrolled in the Takotsubo Italian Network, divided into two groups according to LVEF (≤ 35%, n = 131; > 35%, n = 195), as assessed by transthoracic echocardiography at hospital admission. In-hospital events were recorded in both groups. At long-term follow-up (median 26.5 months, interquartile range 18-33), composite major adverse cardiac events (MACE: cardiac death, acute myocardial infarction, heart failure, and TTS recurrence) and rehospitalization were investigated. Compared to patients with LVEF > 35%, patients with LVEF ≤ 35% were older (71.2 ± 10.8 vs. 68.4 ± 10.6 years; P = 0.026) and experienced more frequently cardiogenic shock (16% vs. 4.6%; P < 0.001), acute heart failure (28.2% vs. 12.8%; P = 0.001), and intra-aortic balloon pump support (11.5% vs. 2.6%; P = 0.001) in the acute phase. At long-term follow-up, higher rates of composite MACE (25.2% vs. 10.8%; P = 0.001) and rehospitalization for cardiac causes (26% vs. 13.3%; P = 0.004) were observed in these patients. LVEF ≤ 35% at admission [hazard ratio (HR) 2.184, 95% confidence interval (CI) 1.231-3.872; P = 0.008] and age (HR 1.041, 95% CI 1.011-1.073; P = 0.006) were independent predictors of MACE. Patients with LVEF ≤ 35% also had a significant lower freedom from composite MACE during long-term follow-up ( 2 = 11.551, P = 0.001).

Predictors of thromboembolic events in Takotsubo syndrome: reply

“…We thank El-Battrawy et al for their interest in our study focused on the prognostic role of severely reduced left ventricular ejection fraction (LVEF) in Takotsubo syndrome (TTS). 1 As they properly state, the in-hospital course of TTS may be threatened by several complications such as cardiogenic shock, pulmonary oedema and malignant arrhythmias, which have been associated with worse prognosis in both the short and long term. [2][3][4] More specifically, El-Battrawy et al wonder whether the rate of thromboembolic events differs in TTS patients according to the LVEF value at presentation.…”

Comparison of mortality in primary and secondary Takotsubo cardiomyopathy with severe left ventricular dysfunction

“…Citro et al 1 performed a commendable morbidity and mortality analysis in patients with Takotsubo cardiomyopathy (TC) with severely reduced left ventricular ejection fraction (LVEF ≤ 35%) from the Takotsubo Italian Network. Compared to patients with LVEF > 35%, patients with LVEF ≤ 35% were older, experienced cardiogenic shock and acute heart failure more frequently, and required more frequent intra-aortic balloon pump support acutely.…”

“…Citro et al . performed a commendable morbidity and mortality analysis in patients with Takotsubo cardiomyopathy (TC) with severely reduced left ventricular ejection fraction (LVEF ≤ 35%) from the Takotsubo Italian Network.…”

Predictors of thromboembolic events in Takotsubo syndrome

“…The article by Citro et al . published in the European Journal of Heart Failure describes the outcome of Takotsubo syndrome (TTS) patients presenting with severely reduced left ventricular ejection fraction (LVEF ≤ 35%) on admission.…”

“…The article by Citro et al 1 published in the European Journal of Heart Failure describes the outcome of Takotsubo syndrome (TTS) patients presenting with severely reduced left ventricular ejection fraction (LVEF ≤ 35%) on admission. Recent data have shown that LVEF ≤ 35% is a key parameter for identifying high-risk patients susceptible to an impaired clinical outcome.…”