Manuel Almendro-Delia1, Iván J Núñez-Gil2, Manuel Lobo3, Mireia Andrés4, Oscar Vedia2, Alessandro Sionis5, Ana Martin-García6, María Cruz Aguilera7, Eduardo Pereyra8, Irene Martín de Miguel9, José A Linares Vicente10, Miguel Corbí-Pascual11, Xavier Bosch12, Oscar Fabregat Andrés13, Alejandro Sánchez Grande Flecha14, Alberto Pérez-Castellanos15, Javier López Pais16, Manuel De Mora Martín17, Juan María Escudier Villa18, Roberto Martín Asenjo19, Marta Guillen Marzo20, Ferrán Rueda Sobella21, Álvaro Aceña22, José María García Acuña23, Juan C García-Rubira3. 1. Unidad Coronaria, Servicio de Cardiología, Hospital Virgen Macarena, Sevilla, Spain. Electronic address: almendrode@secardiologia.es. 2. Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain. 3. Unidad Coronaria, Servicio de Cardiología, Hospital Virgen Macarena, Sevilla, Spain. 4. Servicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain. 5. Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain. 6. S. Cardiología, Hospital Universitario de Salamanca-IBSAL-CIBERCV, Salamanca, Spain. 7. S. Cardiología, Hospital de la Princesa, Madrid, Spain. 8. S. Cardiología, Hospital Universitario Arnau de Vilanova, Lérida, Spain. 9. S. Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 10. S. Cardiología, Hospital Clínico Lozano Blesa, Zaragoza, Spain. 11. Servicio de Cardiología, Hospital Universitario de Albacete, Albacete, Spain. 12. Unidad de Cuidados Cardiacos Agudos, Servicio de Cardiología, Hospital Clinic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain. 13. Servicio de Cardiología, Hospital General Universitario de Valencia, Valencia, Spain. 14. Servicio de Cardiología, Hospital Universitario de Canarias, Tenerife, Spain. 15. Servicio de Cardiología, Hospital de Manacor, Baleares, Spain. 16. Servicio de Cardiología, Hospital Universitario de Getafe, Madrid, Spain. 17. Servicio de Cardiología, Hospital Carlos Haya, Málaga, Spain. 18. Servicio de Cardiología, Hospital Puerta de Hierro, Madrid, Spain. 19. Servicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain. 20. Servicio de Cardiología, Hospital Joan XXIII, Tarragona, Spain. 21. Servicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Spain. 22. Servicio de Cardiología, Fundación Jiménez Díaz, Madrid, Spain. 23. Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago, Spain.
Abstract
OBJECTIVES: This study sought to describe the incidence, determinants, and prognostic impact of cardiogenic shock (CS) in takotsubo syndrome (TTS). BACKGROUND: TTS can be associated with severe hemodynamic instability. The prognostic implication of CS has not been well characterized in large studies of TTS. METHODS: We analyzed patients with a definitive TTS diagnosis (modified Mayo criteria) who were recruited for the National RETAKO (Registry on Takotsubo Syndrome) trial from 2003 to 2016. Cox and competing risk regression models were used to identify factors associated with mortality and recurrences. RESULTS: A total of 711 patients were included, 81 (11.4%) of whom developed CS. Male sex, QTc interval prolongation, lower left ventricular ejection fraction at admission, physical triggers, and presence of "a significant" left intraventricular pressure gradient, were associated with CS (C index = 0.85). In-hospital complication rates, including mortality, were significantly higher in patients with CS. Over a median follow-up of 284 days (interquartile range: 94 to 929 days), CS was the strongest independent predictor of long-term, all-cause mortality (hazard ratio [HR]: 5.38; 95% confidence interval [CI]: 2.60 to 8.38); cardiovascular (CV) death (sub-HR: 4.29; 95% CI: 2.40 to 21.2), and non-CV death (sub-HR: 3.34; 95% CI: 1.70 to 6.53), whereas no significant difference in the recurrence rate was observed between groups (sub-HR: 0.76; 95% CI: 0.10 to 5.95). Among patients with CS, those who received beta-blockers at hospital discharge experienced lower 1-year mortality compared with those who did not receive a beta-blocker (HR: 0.52; 95% CI: 0.44 to 0.79; pinteraction = 0.043). CONCLUSIONS: CS is not uncommon and is associated with worse short- and long-term prognosis in TTS. CS complicating TTS may constitute a marker of underlying disease severity and could identify a masked heart failure phenotype with increased vulnerability to catecholamine-mediated myocardial stunning.
OBJECTIVES: This study sought to describe the incidence, determinants, and prognostic impact of cardiogenic shock (CS) in takotsubo syndrome (TTS). BACKGROUND: TTS can be associated with severe hemodynamic instability. The prognostic implication of CS has not been well characterized in large studies of TTS. METHODS: We analyzed patients with a definitive TTS diagnosis (modified Mayo criteria) who were recruited for the National RETAKO (Registry on Takotsubo Syndrome) trial from 2003 to 2016. Cox and competing risk regression models were used to identify factors associated with mortality and recurrences. RESULTS: A total of 711 patients were included, 81 (11.4%) of whom developed CS. Male sex, QTc interval prolongation, lower left ventricular ejection fraction at admission, physical triggers, and presence of "a significant" left intraventricular pressure gradient, were associated with CS (C index = 0.85). In-hospital complication rates, including mortality, were significantly higher in patients with CS. Over a median follow-up of 284 days (interquartile range: 94 to 929 days), CS was the strongest independent predictor of long-term, all-cause mortality (hazard ratio [HR]: 5.38; 95% confidence interval [CI]: 2.60 to 8.38); cardiovascular (CV) death (sub-HR: 4.29; 95% CI: 2.40 to 21.2), and non-CV death (sub-HR: 3.34; 95% CI: 1.70 to 6.53), whereas no significant difference in the recurrence rate was observed between groups (sub-HR: 0.76; 95% CI: 0.10 to 5.95). Among patients with CS, those who received beta-blockers at hospital discharge experienced lower 1-year mortality compared with those who did not receive a beta-blocker (HR: 0.52; 95% CI: 0.44 to 0.79; pinteraction = 0.043). CONCLUSIONS:CS is not uncommon and is associated with worse short- and long-term prognosis in TTS. CS complicating TTS may constitute a marker of underlying disease severity and could identify a masked heart failure phenotype with increased vulnerability to catecholamine-mediated myocardial stunning.
Authors: Laura Massobrio; Alberto Valbusa; Marina Sartini; Giovanni Meliota; Francesca Cavalla; Roberta Miceli; Giulia Vischi; Maria Luisa Cristina; Anna Maria Spagnolo; Roberto Delfino; Francesco Abbadessa; Italo Porto; Claudio Brunelli; Gian Marco Rosa Journal: Cardiol Res Pract Date: 2019-07-30 Impact factor: 1.866