What is the clinical evidence from this study?

Study design: Observational. Population: Takotsubo cardiomyopathy (n=35). Intervention: Left ventricular outflow tract (LVOT) obstruction vs. No LVOT obstruction. Primary outcome: 3-year all-cause death (p=0.22).

January 1, 2015Open Access

Clinical Impact of Left Ventricular Outflow Tract Obstruction in Takotsubo Cardiomyopathy

TKTetsuma KawajiElectrophysiology HSHiroki ShiomiInterventional Cardiology TMTakeshi MorimotoInterventional Cardiology

Key Result

In patients with takotsubo cardiomyopathy, left ventricular outflow tract obstruction increased 3-year heart failure hospitalization and recurrence, but did not significantly affect mortality.

Study Design

Type

Observational (n=35)

Multicenter

Structured PICO

Does left ventricular outflow tract (LVOT) obstruction worsen clinical presentation and long-term outcomes in patients with Takotsubo cardiomyopathy?

Population

35 consecutive patients (median age 76, 83% female) diagnosed with takotsubo cardiomyopathy after emergency angiography for suspected acute coronary syndrome, followed for a mean of 4.7 years.

Exposure

Presence of significant left ventricular outflow tract (LVOT) obstruction (defined as peak-to-peak pressure gradient >20 mmHg)

Comparator

Absence of significant left ventricular outflow tract (LVOT) obstruction

Outcome

Cumulative 3-year incidence of all-cause death, cardiac death, hospitalization for congestive heart failure (CHF), myocardial infarction (MI), stroke, and recurrent TChard clinical

In patients with Takotsubo cardiomyopathy, significant LVOT obstruction is common (33%) and is associated with a more severe initial clinical presentation and higher rates of heart failure hospitalization and recurrence, though it does not significantly impact 3-year mortality.

Main Result

Absolute Event Rate: 49.2% vs 23%

p-value: p=0.22

Limitations

Small number of patients in a single-center observational study
Missing information on LVOT pressure gradient in a certain number of patients

Abstract

BACKGROUND: A hyperdynamic state of the basal left ventricle sometimes results in obstruction of the left ventricular outflow tract (LVOT). However, the prevalence, clinical presentation, and prognostic effect of LVOT obstruction in takotsubo cardiomyopathy (TC) have not been fully evaluated. METHODS AND RESULTS: Among 933 consecutive patients who underwent emergency coronary angiography for suspected acute coronary syndrome, 35 patients (3.8%) were diagnosed as TC. The cumulative 3-year incidence of all-cause death, cardiac death, hospitalization for congestive heart failure (CHF), and recurrent TC was 24.2%, 0.0%, 6.5%, and 12.2%, respectively. Among 27 patients with information of a LVOT pressure gradient, LVOT obstruction was present in 9 (33%). The prevalence of moderate to severe mitral regurgitation (67% vs. 11%, P=0.003), CHF (78% vs. 28%, P=0.02), and hypotension (56% vs. 5.6%, P=0.008) was significantly higher in patients with LVOT obstruction than in those without. Nevertheless, the cumulative 3-year incidence of all-cause death was not significantly different between the 2 groups (49.2% vs. 23.0%, P=0.22) with no cardiac deaths in either group. Hospitalization for CHF and recurrent TC were significantly more frequent in patients with LVOT obstruction (25.0% vs. 0.0%, P=0.04, and 25.0% vs. 6.7%, P=0.02). CONCLUSIONS: In 35 consecutive patients with TC, those with significant LVOT obstruction (33%) had a more serious clinical presentation such as CHF and hypotension, but had similar 3-year mortality rate as compared with those without.

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