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Impact and management of left ventricular function on the prognosis of Takotsubo syndrome
Author(s) -
ElBattrawy Ibrahim,
Ansari Uzair,
Lang Siegfried,
Behnes Michael,
Schramm Katja,
Fastner Christian,
Zhou Xiaobo,
Kuschyk Jürgen,
Tülümen Erol,
Röger Susanne,
Borggrefe Martin,
Akin Ibrahim
Publication year - 2017
Publication title -
european journal of clinical investigation
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.164
H-Index - 107
eISSN - 1365-2362
pISSN - 0014-2972
DOI - 10.1111/eci.12768
Subject(s) - medicine , ejection fraction , cardiogenic shock , clinical endpoint , cardiology , mortality rate , population , takotsubo syndrome , heart failure , randomized controlled trial , myocardial infarction , cardiomyopathy , environmental health
Abstract Background Early research has proposed that patients with Takotsubo syndrome ( TTS ) could have a higher mortality rate than the general population. Our study was conducted to determine the short‐ and long‐term outcome of TTS patients associated with a significantly compromised left ventricular function on hospital admission. Materials and methods Our institutional database constituted a collective of 112 patients diagnosed with TTS between 2003 and 2015. The patients were classified into two groups based on the left ventricular ejection fraction ( LVEF ), with those presenting with a LVEF > 35% on admission categorized into one group ( n = 65, 58%) and those presenting with LVEF ≤ 35% ( n =47, 42%) categorized into another group. The endpoint was the all‐cause of mortality over a mean follow‐up of 1529 ± 1121 days. Results Preliminary results indicated that patients with an EF ≤ 35% had a significantly greater risk of developing life‐threatening arrhythmias, and were much more likely to suffer from cardiogenic shock. Patients often required varying forms of mechanical respiratory support. The in‐hospital mortality, 30‐day mortality, 1‐year mortality and ongoing long‐term mortality was significantly higher in TTS patients with an EF ≤ 35%. In a multivariate Cox regression analysis, an EF ≤ 35% ( HR 3·3, 95% CI : 1·2–9·2, P < 0·05) was identified as a strong independent predictor of the primary endpoint. Conclusions In‐hospital events as well as short‐ and long‐term mortality rates among TTS patients diagnosed with a significantly reduced LVEF on admission were significantly higher. There is an urgent need for randomized trials, which could help define uniform clinical management strategies for high risk TTS patients.