Renal dysfunction indicative of outcomes in hospitalized patients with takotsubo syndrome

Ando, Kaoru; Sukekawa, Hiroyasu; Takahata, Aoi; Kobari, Yusuke; Takahashi, Hayato; Ishigaki, Daisuke; Takahashi, Toshiaki; Koyama, Yo

doi:10.1177/2048872617715019

Cited by 13 publications

(15 citation statements)

References 38 publications

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“…In Chinese patients with TTS and CKD undergoing primary percutaneous coronary intervention, 30 -day mortality was 4.08%, 1 -year mortality was 7.95%, and renal dysfunction (both CKD [19.7%] and AKI [29.5%]) developed in 49% of patients, whereas in a Korean study by Shin et al, 8 7 of 30 patients with stress -induced cardiomyopathy had renal dysfunction (4 on hemodialysis and 3 with AKI). 16 Other studies on TTS did not assess kidney function, serum creatinine levels, or eGFR.…”

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confidence: 99%

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Takotsubo syndrome and chronic kidney disease - deadly duet in long-term follow-up

Zalewska-Adamiec¹,

Małyszko²,

Bachórzewska−Gajewska³

et al. 2018

Polish Archives of Internal Medicine

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Introduction The prognosis of takotsubo syndrome (TTS) was recognized as benign. However, patients with TTS and chronic kidney disease (CKD) more often experience severe complications in the acute phase of the disease, particularly sudden cardiac arrest. Objectives We aimed to assess the impact of CKD on early and long-term outcomes, including mortality, among 95 patients with TTS. Patients and methods All patients underwent coronary angiography. Clinical, biochemical, and other medical data were recorded. Estimated glomerular filtration rate was assessed using the CKD‑EPI formula. Results CKD was diagnosed in 32% of the patients. Contrast‑induced acute kidney injury (CI‑AKI) was not reported in any of the patients. Patients with CKD were older but had a lower prevalence of positive cardiovascular family history as well as higher creatine kinase activity and concentrations of inflammatory parameters. During hospitalization, sudden cardiac arrest was more common in CKD patients. In‑hospital, 1‑year, and long‑term mortality rates were the highest in CKD patients, reaching 33.3% in long‑term follow‑up. Predictors of death in a multivariate analysis were body mass index, ejection fraction, and serum creatinine concentrations. Conclusions CKD is a novel and still underestimated risk factor for TTS. It may trigger TTS but, more importantly, it adversely affects the outcomes. Thus, it is important to assess kidney function in all patients with TTS to evaluate the risk of morbidity and mortality in follow‑up, as well as to adjust drug doses and implement preventive measures to avoid CI‑AKI when coronary angiography or contrast‑enhanced computed tomography is performed.

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Section: -22mentioning

confidence: 99%

“…This finding has not been reported by previous studies. [14][15][16][17] Ando et al 16 showed that renal dysfunction in TTS was associated with the development of For commercial use, please contact the journal office at pamw@mp.pl.…”

Section: -22mentioning

confidence: 99%

Takotsubo syndrome and chronic kidney disease - deadly duet in long-term follow-up

Zalewska-Adamiec¹,

Małyszko²,

Bachórzewska−Gajewska³

et al. 2018

Polish Archives of Internal Medicine

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“…In our previous publication, low BMI proved to be a significant death risk factor during the 3-year observation of patients with TS [7], which prompted us to perform additional analyses in longer follow-up [7]. In recently published papers the BMI value is mainly described as the average value characterising the takotsubo group, or it is used to distinguish the group of obese patients [6,23]. Desai et al [24] stated that obese patients with TS revealed a higher risk of severe complications during the final stage of the disease (sudden cardiac arrest, cardiogenic shock, respiratory failure, necessity to implement devices providing left ventricular hemodynamic support), whereas in-hospital mortality was similar to values observed in the group of patients who were not obese.…”

Section: Discussionmentioning

confidence: 99%

Takotsubo syndrome – fatal prognosis of patients with low body mass index in 5-year follow-up

Zalewska-Adamiec¹,

Małyszko²,

Bachórzewska−Gajewska³

et al. 2020

aoms

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Introduction: The clinical courses of takotsubo syndrome (TS) and of acute coronary syndromes (ACS) seem to be very similar. However, there is limited knowledge about risk factors of poor outcomes. Low body mass index worsens the prognosis of patients with cardiovascular diseases, especially those undergoing surgical treatment. The aim of the study was to evaluate the influence of the body mass index (BMI) on the prognosis in patients diagnosed with TS. Material and methods: Eighty patients aged 15-89 (mean: 67.9 years), 74 women and 6 men with TS diagnosis according to Mayo Clinic diagnostic criteria were divided into 3 groups: low body mass (BMI < 18.5 kg/m 2), normal body mass (18.5 ≥ BMI < 25 kg/m 2) and excessive body mass (BMI ≥ 25 kg/m 2). Results: Patients with low BMI were older, but with less prevalent risk factors such as hypertension, hypercholesterolemia and positive family history of coronary artery disease and more frequent risk factors such as cigarette smoking, chronic obstructive pulmonary disease (COPD), depressive and anxiety disorders as well as malignancy. They also had higher haemoglobin, lower troponin, creatine kinase, C-reactive protein and lipid fractions. The highest annual, 3-year and 5-year mortality was observed in the group with BMI < 18.5 kg/m 2. None of the patients with low BMI survived the 5-year follow-up period (100% vs. 25% vs. 15.2%; p < 0.0001). In group III, mortality among overweight patients (25 ≥ BMI < 30 kg/m 2) was 8.3%, and in obese people (BMI ≥ 30 kg/m 2) 1 out 5 patients died during follow-up. Conclusions: The majority of typical cardiovascular risk factors are less frequently observed in patients with TS and low body mass. Early prognosis for TS patients and low BMI is relatively favourable, whereas the 5-year follow-up is associated with extremely high mortality. Overweight patients have the best prognosis in the long-term follow-up.

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“…Nonetheless, several complications during in-hospital course and follow up may occur in TTS with an event rate comparable to that observed in patients with acute coronary syndrome (ACS) [4][5][6][7] . However, both short 8,9 and long-term 6,10 prognosis remain quite heterogeneous in TTS, which supports the need of improved risk stratification in order to identify those patients who may most benefit from intensive in-hospital management and long-term clinical follow-up 11 . Dyspnea at presentation is associated with worse prognosis in ACS 12 , and its assessment was able to improve accuracy of a traditional risk stratification model in these patients 13 .…”

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confidence: 99%

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

Arcari

Musumeci

Stiermaier

et al. 2020

Sci Rep

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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

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Renal dysfunction indicative of outcomes in hospitalized patients with takotsubo syndrome

Abstract: Renal dysfunction is a simple but useful means of predicting complications in hospitalized patients with takotsubo syndrome, especially those with chronic kidney disease.

Cited by 13 publications

References 38 publications

Takotsubo syndrome and chronic kidney disease - deadly duet in long-term follow-up

Takotsubo syndrome and chronic kidney disease - deadly duet in long-term follow-up

Takotsubo syndrome – fatal prognosis of patients with low body mass index in 5-year follow-up

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

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