Rodolfo Citro1, Eduardo Bossone2, Guido Parodi3, Scipione Carerj4, Quirino Ciampi5, Gennaro Provenza6, Concetta Zito4, Costantina Prota2, Angelo Silverio2, Olga Vriz7, Antonello D'Andrea8, Gennaro Galasso2, Cesare Baldi2, Fausto Rigo9, Massimo Piepoli10, Jorge Salerno-Uriarte11, Federico Piscione2. 1. Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy; Department of Heart Sciences, Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy. Electronic address: rodolfocitro@gmail.com. 2. Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy. 3. Division of Cardiology, Careggi Hospital, Florence, Italy. 4. Division of Cardiology, University of Messina, Messina, Italy. 5. Division of Cardiology, Ospedale Fatebenefratelli, Benevento, Italy. 6. Division of Cardiology, San Francesco d'Assisi, Oliveto Citra, Salerno, Italy. 7. Cardiology and Emergency Department, San Antonio Hospital, San Daniele del Friuli, Udine, Italy. 8. Department of Cardiology, Second University of Naples, Naples, Italy. 9. Department of Cardiology, Dell'Angelo Hospital, Mestre, Italy. 10. Division of Cardiology, Ospedale Guglielmo da Saliceto, Piacenza, Italy. 11. Department of Heart Sciences, Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy.
Abstract
AIM: To determine the prevalence, clinical characteristics, in-hospital course and determinants of major adverse events in a cohort of Caucasian patients with Takotsubo syndrome (TTS) and right ventricular involvement (RVi), regardless of left ventricular variant forms. METHODS AND RESULTS: The study population consisted of 424 patients (mean age 69.1±11.5years; female 92.2%) with a diagnosis of TTS divided into two groups according to the presence or absence of RVi. RVi patients (n=57; 13.4%) showed a higher prevalence of comorbidities, especially respiratory diseases (p=0.011), and a higher Charlson comorbidity index (CCI; p=0.006) than non-RVi patients. In-hospital major adverse events (acute heart failure, cardiogenic shock and death) occurred more frequently in RVi patients (p<0.001). Heart rate and CCI, along with the echocardiographic parameters of wall motion score index, E/e' ratio, tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP) were associated with adverse in-hospital outcome. At multivariate analysis, CCI (HR: 1.871; 95% CI: 1.202-2.912; p=0.006), sPAP (HR: 1.059; 95% CI: 1.016-1.104; p=0.007) and TAPSE (HR: 0.728; 95% CI: 0.619-0.855; p<0.001) were independent correlates of the composite outcome in patients with RVi. CONCLUSION: Patients with RVi are characterized by distinct clinical profile and should undergo closely clinical and echocardiographic monitoring. The presence of echocardiographic signs of right ventricular failure along with substantial comorbidities burden identify a cohort at higher risk of in-hospital major adverse cardiovascular events.
AIM: To determine the prevalence, clinical characteristics, in-hospital course and determinants of major adverse events in a cohort of Caucasian patients with Takotsubo syndrome (TTS) and right ventricular involvement (RVi), regardless of left ventricular variant forms. METHODS AND RESULTS: The study population consisted of 424 patients (mean age 69.1±11.5years; female 92.2%) with a diagnosis of TTS divided into two groups according to the presence or absence of RVi. RVi patients (n=57; 13.4%) showed a higher prevalence of comorbidities, especially respiratory diseases (p=0.011), and a higher Charlson comorbidity index (CCI; p=0.006) than non-RVi patients. In-hospital major adverse events (acute heart failure, cardiogenic shock and death) occurred more frequently in RVi patients (p<0.001). Heart rate and CCI, along with the echocardiographic parameters of wall motion score index, E/e' ratio, tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP) were associated with adverse in-hospital outcome. At multivariate analysis, CCI (HR: 1.871; 95% CI: 1.202-2.912; p=0.006), sPAP (HR: 1.059; 95% CI: 1.016-1.104; p=0.007) and TAPSE (HR: 0.728; 95% CI: 0.619-0.855; p<0.001) were independent correlates of the composite outcome in patients with RVi. CONCLUSION:Patients with RVi are characterized by distinct clinical profile and should undergo closely clinical and echocardiographic monitoring. The presence of echocardiographic signs of right ventricular failure along with substantial comorbidities burden identify a cohort at higher risk of in-hospital major adverse cardiovascular events.
Authors: Caroline Scally; Amelia Rudd; Alice Mezincescu; Heather Wilson; Janaki Srivanasan; Graham Horgan; Paul Broadhurst; David E Newby; Anke Henning; Dana K Dawson Journal: Circulation Date: 2017-11-11 Impact factor: 29.690