In patients with Takotsubo syndrome, LVEF <50% at admission was a significant predictor of in-hospital complications (OR 0.20; 95% CI 0.06-0.73; p=0.014).
Cohort (n=107)
No
In a contemporary Portuguese cohort, Takotsubo syndrome generally had a benign course with LVEF recovery, though a subset experienced severe complications predicted by admission LVEF <50%.
Odds Ratio: 0.2 (95% CI 0.06–0.73)
p-value: p=0.014
Abstract Background Takotsubo syndrome (TTS) is a cause of acute heart failure (AHF), and its presentation mimics an acute coronary syndrome. Despite its classical presentation as an acute transient left ventricular dysfunction preceded by a specific trigger, a variety of clinical courses and outcomes have been described. We aimed to characterize a contemporary cohort of patients with TTS. Methods Retrospective analysis of patients diagnosed with TTS admitted to a tertiary care center between 2009-2024. Baseline characteristics, clinical presentation and in-hospital complications, serial cardiac imaging and short-term outcomes at first outpatient follow-up appointment were analyzed. Results A total of 107 patients (72±12 years, 86% women) were included. The most common presenting symptom was chest pain (66%; n=71), with an identified trigger in 50% of patients. A recurrent episode was present in 5 patients. ST-segment elevation was the most frequent finding on ECG (47%, n=40), accompanied by troponin (peak 719 ng/L IQR 280-1478) and NTproBNP (peak 5162 pg/ml IQR 2399-11204) elevation. Regional wall motion abnormalities were identified by TTE (n=100) and/or ventriculography (n=48), with apical ballooning by TTE and ventriculography on 86% and 81% of patients, respectively. Left ventricular ejection fraction (LVEF) was preserved in around 1/3 of patients, mildly reduced in 1/3 and reduced in 1/3. Obstructive CAD was evaluated in 87% (n=93) and excluded in 88% (n=82) of patients; no percutaneous coronary intervention was performed. Most patients had an uncomplicated clinical course and LVEF improved significantly before discharge (figure 1). However, 15% of patients presented with AHF, including 6.5% in cardiogenic shock. Cardiac arrest occurred in 5.6%, and in-hospital mortality was 3.8% (n=4). LVEF 50% at admission was a predictor of in-hospital complications (OR 0.20, 95%CI 0.06-0.73, p=0.014). At discharge, 69% of patients were on angiotensin converting enzyme inhibitors and 73% were on beta-blocker. The first follow-up appointment (median 3 months IQR 1-4) was attended by 67 patients, with no TTS recurrences or readmissions in this timeframe. LVEF was reassessed in 47 patients at follow-up, maintaining significant improvement (figure 1). Conclusion TTS represents a relevant cause of cardiac hospitalization, and despite a benign course, some patients still have worse outcomes. Long-term follow-up with routine multimodality imaging might shed light on pathophysiology and predictors of worse outcomes.
Jorge et al. (Sat,) conducted a cohort in Takotsubo syndrome (n=107). LVEF <50% at admission was evaluated on in-hospital complications (OR 0.20, 95% CI 0.06-0.73, p=0.014). In patients with Takotsubo syndrome, LVEF <50% at admission was a significant predictor of in-hospital complications (OR 0.20; 95% CI 0.06-0.73; p=0.014).