Predictive Value of QRS Duration at Admission for In-Hospital Clinical Outcome of Takotsubo Cardiomyopathy

Abstract

ing, multicenter, population-based cohort database of emergency admissions to acute cardiac care facilities in Tokyo. It was launched in 1978 and expanded to 71 largevolume cardiovascular facilities. We launched the TC research group in 2010 and started collecting data on patients with TC admitted to facilities participating in the Tokyo CCU Network. Data on TC patients were collected retrospectively, and included original copies of ECG for a 3-year period between 2010 and 2012. Data have been collected prospectively since 2013, but do not include original copies of ECG. Therefore, we used data collected between 2010 and 2012 for this study. The requirement for informed consent was waived because all data were anonymously catalogued. As stated in a preceding article from a Tokyo CCU Network registered cohort, 11 patient data collection policies are displayed at the emergency entrance of each facility in accordance with rules set forth by the Ministry of Internal Affairs and Communications. The aim of the registry and personal information protection policy T akotsubo cardiomyopathy (TC) is characterized by reversible left ventricular (LV) dysfunction not caused by coronary artery disease (CAD). 1-3 The in-hospital mortality rate is between 0% and 8%, 2-5 and the rate of major adverse cardiac and cerebrovascular events is 7.1%. 5 J wave and QT prolongation on electrocardiogram (ECG) are predictors of short-term outcome in TC, 6,7 but the prognostic impact of prolonged QRS duration (pQRSd) in TC remains unknown, although it is a strong predictor of poor outcome in previous myocardial infarction, congestive heart failure (HF), and myocarditis. 8- 10 The aim of the present study was to examine the predictive value of pQRSd for in-hospital clinical outcomes of TC, using a multicenter database in Japan. Methods SubjectsThe Tokyo CCU Network database is a prospective, ongo- Background: Prolonged QRS duration (pQRSd) on electrocardiogram (ECG) is a strong predictor of poor outcome in heart failure, myocardial infarction, and myocarditis, but it is unclear whether pQRSd also predicts poor outcomes of takotsubo cardiomyopathy (TC).

Clinical characteristics of patients with Takotsubo syndrome diagnosed without coronary artery evaluation: A retrospective nationwide study

“…The current major diagnostic criteria for TTS requiring the absence of culprit coronary artery disease make it mandatory to perform CAE before the diagnosis of TTS can be made [2][3][4][5][6][7]. Consequently, all recent studies with relatively large samples (n > 250) enrolled only patients who underwent CAE (mostly CAG) [10,27,28,30,31,[35][36][37][38]. Nevertheless, this and other studies [8,9,39] have shown that a substantial proportion (35-78%) of patients with the diagnosis of TTS received this diagnosis without CAE in real-world clinical settings.…”

“…Nevertheless, this and other studies [8,9,39] have shown that a substantial proportion (35-78%) of patients with the diagnosis of TTS received this diagnosis without CAE in real-world clinical settings. These patients who did not undergo CAE were not enrolled in the recent TTS studies [10,27,28,30,31,[35][36][37][38] because they did not fulfill the current diagnostic criteria. Thus, the studies may have underestimated the incidence of TTS due to a selection bias associated with the diagnostic criteria.…”

“…Sixth, cause of death was not recorded in the DPC database. Although patients diagnosed with TTS reportedly often have noncardiac comorbidities [10][11][12] that can cause non-cardiac death [27,37,39,43], we were unable to investigate the differences in the incidences of cardiac and non-cardiac death between the CAE (+) and CAE (À) groups. Finally, our results may not be generalizable to patients hospitalized with TTS at non-Japanese Circulation Society board-certified teaching hospitals or hospitals in other countries.…”

Can you interpret the ECG under stress?

“…(19) Prolonged QRS duration is also associated with higher in-hospital mortality, cardiac death, ventilator use, ventricular arrhythmias and circulatory failure. (20) Other reported adverse prognostic markers include a higher heart rate and larger sum of ST elevations in all 12 leads. (21) Persistent Q waves are a poor prognostic marker.…”

Impact of Trigger on Outcome of Takotsubo Syndrome ― Multi-Center Registry From Tokyo Cardiovascular Care Unit Network ―

“…The registry was registered under the University Hospital Medical Information Network Clinical Trials Registry (UMIN000013128) and is described in detail in another study. 10 Since the establishment of the Takotsubo Cardiomyopathy Study Group of the Tokyo CCU Network Scientific Committee in 2010, inpatient data on TTS were collected retrospectively between 2010 and 2012. Since 2013, inpatient data on TTS have been collected prospectively.…”