Krishna Ravindra1, Marco G Del Buono2,3, Juan G Chiabrando1,4,5, Peter Westman1, Edoardo Bressi1, Dinesh Kadariya1, Curtis Maehara1, Megan Dell1, Liangsuo Ma6, Jessie VAN Wezenbeek1, F Gerard Moeller7, Lori Keyser-Marcus7, Larry D Keen8, Tamas S Gal9, Antonio Abbate1. 1. Pauley Heart Center, Virginia Commonwealth University Hospital, Richmond, VA, USA. 2. Pauley Heart Center, Virginia Commonwealth University Hospital, Richmond, VA, USA - marcodelbuono@hotmail.it. 3. Department of Cardiovascular and Pulmonary Sciences, Sacred Heart Catholic University, Rome, Italy. 4. Interventional Cardiology Service, Italian Hospital of Buenos Aires, Buenos Aires, Argentina. 5. Laboratory of Applied Health Statistics (LEACS), School of Medicine, University of Buenos Aires, Buenos Aires, Argentina. 6. Department of Radiology, Virginia Commonwealth University Hospital, Richmond, VA, USA. 7. Department of Psychiatry, Virginia Commonwealth University Hospital, Richmond, VA, USA. 8. Department of Psychology, Virginia State University, Petersburg, VA, USA. 9. Department of Biostatistics, Virginia Commonwealth University Hospital, Richmond, VA, USA.
Abstract
BACKGROUND: Takotsubo syndrome (TS) is an acute, reversible form of heart failure, often mimicking an acute coronary syndrome (ACS). Data regarding racial differences in TS are inconsistent. The aim is to assess clinical features associated with unfavorable in-hospital outcomes between African American (AA) and Caucasian (CAU) patients. METHODS: A retrospective electronic health record query identified 44 AA patients and 110 CAU patients with a diagnosis of TS. Our primary outcome was a composite of death, stroke, and cardiogenic shock during hospitalization. Variables associated with an increased risk of the primary composite outcomes were included in a logistic regression model. RESULTS: Compared to CAU patients, AA patients were a more comorbid population, and presented a higher prevalence of history of illicit drug use (27.3% vs. 13.6% P=0.044). There were no significant differences regarding in-hospital complication rates between AA and CAU patients. In the logistic regression model, infection was associated with greater risk of developing the primary outcome in AA patients (OR=7.26 [95% CI 1.22-43.17], P=0.029), whereas angina was a protective factor (OR=0.11 [95% CI 0.02-0.65], P=0.015). In CAU patients, severely depressed ejection fraction and worse peak creatinine during hospitalization increased risk of developing the primary outcome (OR=5.88 95% CI [2.01-17.17], P<0.001 and OR=1.64 [95% CI 1.15-2.58], P=0.031, respectively). Meanwhile, emotional stressors were protective (OR=0.16 [95% CI 0.03-0.88], P=0.004). CONCLUSIONS: Despite experiencing the same rate of in-hospital complications, the clinical profiles of AA patients are distinct from CAU patients admitted for TS, and clinical variables correlated with worse in-hospital outcomes also differ by race.
BACKGROUND: Takotsubo syndrome (TS) is an acute, reversible form of heart failure, often mimicking an acute coronary syndrome (ACS). Data regarding racial differences in TS are inconsistent. The aim is to assess clinical features associated with unfavorable in-hospital outcomes between African American (AA) and Caucasian (CAU) patients. METHODS: A retrospective electronic health record query identified 44 AA patients and 110 CAU patients with a diagnosis of TS. Our primary outcome was a composite of death, stroke, and cardiogenic shock during hospitalization. Variables associated with an increased risk of the primary composite outcomes were included in a logistic regression model. RESULTS: Compared to CAU patients, AA patients were a more comorbid population, and presented a higher prevalence of history of illicit drug use (27.3% vs. 13.6% P=0.044). There were no significant differences regarding in-hospital complication rates between AA and CAU patients. In the logistic regression model, infection was associated with greater risk of developing the primary outcome in AA patients (OR=7.26 [95% CI 1.22-43.17], P=0.029), whereas angina was a protective factor (OR=0.11 [95% CI 0.02-0.65], P=0.015). In CAU patients, severely depressed ejection fraction and worse peak creatinine during hospitalization increased risk of developing the primary outcome (OR=5.88 95% CI [2.01-17.17], P<0.001 and OR=1.64 [95% CI 1.15-2.58], P=0.031, respectively). Meanwhile, emotional stressors were protective (OR=0.16 [95% CI 0.03-0.88], P=0.004). CONCLUSIONS: Despite experiencing the same rate of in-hospital complications, the clinical profiles of AA patients are distinct from CAU patients admitted for TS, and clinical variables correlated with worse in-hospital outcomes also differ by race.
Authors: Jelena R Ghadri; Ken Kato; Victoria L Cammann; Sebastiano Gili; Stjepan Jurisic; Davide Di Vece; Alessandro Candreva; Katharina J Ding; Jozef Micek; Konrad A Szawan; Beatrice Bacchi; Rahel Bianchi; Rena A Levinson; Manfred Wischnewsky; Burkhardt Seifert; Susanne A Schlossbauer; Rodolfo Citro; Eduardo Bossone; Thomas Münzel; Maike Knorr; Susanne Heiner; Fabrizio D'Ascenzo; Jennifer Franke; Annahita Sarcon; L Christian Napp; Milosz Jaguszewski; Michel Noutsias; Hugo A Katus; Christof Burgdorf; Heribert Schunkert; Holger Thiele; Johann Bauersachs; Carsten Tschöpe; Burkert M Pieske; Lawrence Rajan; Guido Michels; Roman Pfister; Alessandro Cuneo; Claudius Jacobshagen; Gerd Hasenfuß; Mahir Karakas; Wolfgang Koenig; Wolfgang Rottbauer; Samir M Said; Ruediger C Braun-Dullaeus; Adrian Banning; Florim Cuculi; Richard Kobza; Thomas A Fischer; Tuija Vasankari; K E Juhani Airaksinen; Grzegorz Opolski; Rafal Dworakowski; Philip MacCarthy; Christoph Kaiser; Stefan Osswald; Leonarda Galiuto; Filippo Crea; Wolfgang Dichtl; Klaus Empen; Stephan B Felix; Clément Delmas; Olivier Lairez; Ibrahim El-Battrawy; Ibrahim Akin; Martin Borggrefe; John Horowitz; Martin Kozel; Petr Tousek; Petr Widimský; Ekaterina Gilyarova; Alexandra Shilova; Mikhail Gilyarov; David E Winchester; Christian Ukena; Jeroen J Bax; Abhiram Prasad; Michael Böhm; Thomas F Lüscher; Frank Ruschitzka; Christian Templin Journal: J Am Coll Cardiol Date: 2018-08-21 Impact factor: 24.094
Authors: Kevin A Bybee; Tomas Kara; Abhiram Prasad; Amir Lerman; Greg W Barsness; R Scott Wright; Charanjit S Rihal Journal: Ann Intern Med Date: 2004-12-07 Impact factor: 25.391
Authors: Chiara Sonnino; Benjamin W Van Tassell; Stefano Toldo; Marco Giuseppe Del Buono; F Gerard Moeller; Antonio Abbate Journal: Auton Neurosci Date: 2017-11-02 Impact factor: 3.145
Authors: Christian Templin; Jelena R Ghadri; Johanna Diekmann; L Christian Napp; Dana R Bataiosu; Milosz Jaguszewski; Victoria L Cammann; Annahita Sarcon; Verena Geyer; Catharina A Neumann; Burkhardt Seifert; Jens Hellermann; Moritz Schwyzer; Katharina Eisenhardt; Josef Jenewein; Jennifer Franke; Hugo A Katus; Christof Burgdorf; Heribert Schunkert; Christian Moeller; Holger Thiele; Johann Bauersachs; Carsten Tschöpe; Heinz-Peter Schultheiss; Charles A Laney; Lawrence Rajan; Guido Michels; Roman Pfister; Christian Ukena; Michael Böhm; Raimund Erbel; Alessandro Cuneo; Karl-Heinz Kuck; Claudius Jacobshagen; Gerd Hasenfuss; Mahir Karakas; Wolfgang Koenig; Wolfgang Rottbauer; Samir M Said; Ruediger C Braun-Dullaeus; Florim Cuculi; Adrian Banning; Thomas A Fischer; Tuija Vasankari; K E Juhani Airaksinen; Marcin Fijalkowski; Andrzej Rynkiewicz; Maciej Pawlak; Grzegorz Opolski; Rafal Dworakowski; Philip MacCarthy; Christoph Kaiser; Stefan Osswald; Leonarda Galiuto; Filippo Crea; Wolfgang Dichtl; Wolfgang M Franz; Klaus Empen; Stephan B Felix; Clément Delmas; Olivier Lairez; Paul Erne; Jeroen J Bax; Ian Ford; Frank Ruschitzka; Abhiram Prasad; Thomas F Lüscher Journal: N Engl J Med Date: 2015-09-03 Impact factor: 91.245
Authors: John A Spertus; Philip G Jones; Frederick A Masoudi; John S Rumsfeld; Harlan M Krumholz Journal: Ann Intern Med Date: 2009-03-03 Impact factor: 25.391
Authors: Aitor Uribarri; Iván J Núñez-Gil; D Aritza Conty; Oscar Vedia; Manuel Almendro-Delia; Albert Duran Cambra; Agustin C Martin-Garcia; Marisa Barrionuevo-Sánchez; Manuel Martínez-Sellés; Sergio Raposeiras-Roubín; Marta Guillén; Jose Maria Garcia Acuña; Lucía Matute-Blanco; José A Linares Vicente; Alejandro Sánchez Grande Flecha; Mireia Andrés; Alberto Pérez-Castellanos; Javier Lopez-Pais Journal: J Am Heart Assoc Date: 2019-12-13 Impact factor: 5.501