Clinical features and outcomes of focal Takotsubo syndrome. Data from a prospective european registry of 3741 patients

Background Focal forms of Takotsubo syndrome (TTS) have a relatively low incidence and are not well characterized. Objectives To describe clinical features and outcomes of focal TTS. Methods TTS patients were enrolled from the international multicenter GEIST (German-Italian-Spanish Takotsubo) registry. Focal TTS was defined as reversible focal hypo-, a- or dyskinesia of any segment of the left ventricle with no circumferential distribution. Clinical features and in-hospital and long-term outcomes were compared between focal TTS and other ballooning patterns. Results Among 3741 patients enrolled, 62 (1.6%) were diagnosed with focal TTS. Patients with focal TTS were younger (64±14 vs 70±11 y, p=0.01) and had higher admission LVEF (53±8% vs 33±20%,p<0.01) than the control TTS group. Prevalence of emotional stressor was higher in the focal group (49% vs 35%,p=0.02) while physical triggers were more common in the control TTS group (36% vs 22%, p=0.03). Admission serum levels of NT-proBNP were lower in patients with focal TTS than the control TTS group (1434±688 vs 8699±1553 pg/ml, p<0.01). Focal TTS forms involved 2.1±1 left ventricular wall segments and were distributed among antero-lateral (75%) and infero-septal (25%) LV segments. In-hospital complications, including death, pulmonary edema, cardiogenic shock, or stroke were lower in the focal group (8% vs 23%, p=0.01), while 30-days and long-term mortality was similar between groups (log-rank p=0.45 and p=0.07, respectively). Conclusions Focal TTS is rare and more often involves the antero-lateral left ventricular segments. Although this form has lower rate of in-hospital complication, long-term outcome is similar to other TTS forms.