A novel parameter for risk stratification in patients with takotsubo syndrome

Background and aims Takotsubo syndrome (TTS) is an acute reversible cardiomyopathy characterized by transient reduction in left ventricular ejection fraction (LVEF) with typical echocardiographic appearance. The syndrome is often preceded by emotional or physical trigger and predominantly affects postmenopausal women. Several biomarkers and scores have been suggested for risk stratification in TTS. In this retrospective study, we aimed to evaluate the association between fibrinogen-to-albumin ratio (FAR) and outcomes in patients with TTS. Methods We assessed the association of FAR with LVEF, in-hospital complications, and readmissions in patients with TTS. Results A total of 116 patients (94% female, mean age 70 years) were included in the final analysis. The mean LVEF was 45% and the mean FAR was 129. In-hospital complications occurred in 34 patients (29%) while 26 patients (22%) were readmitted. A higher FAR was associated with a lower LVEF [Odds ratio (OR) 1.48, 95% confidence interval (CI) 1.25–1.74, p < 0.001] and in-hospital complications (OR 1.18, 95% CI 1.02–1.37, p < 0.025), including heart failure (HF) signs and arrhythmia. Patients with higher FAR values also had a higher rate of readmissions. A FAR cutoff value of 136 may help identify patients at increased risk of complications. Conclusion In patients with TTS, higher FAR values were associated with lower LVEF and increased rates of in-hospital complications and readmissions for HF. FAR may represent a promising biomarker for risk stratification, however, its prognostic value requires validation in larger, external prospective cohorts.