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Prognostic implications of left ventricular systolic dysfunction in patients with Takotsubo Syndrome
Session:
Posters 2 - Écran 09 - Miocárdio e Pericárdio
Speaker:
Catarina Ruivo
Congress:
CPC 2018
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.2 Myocardial Disease – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Catarina Ruivo; Nuno Marques; Bebiana Faria; Rui Pontes Santos; Nuno Craveiro; Ana I. Marques; Hugo Da Silva Antunes; Liliana Reis; Rui Azevedo Guerreiro; Olga Azevedo
Abstract
<p>BACKGROUND</p> <p>A reduced left ventricular systolic function at presentation is a well-established prognostic determinant in patients with several cardiovascular disease. Takotsubo Syndrome (TS) is now increasingly recognized by the medical community, however many facets of this condition are incompletely understood or characterized, in particular, its long term prognosis. We sought to investigate the prognostic impact of left ventricular ejection fraction (LVEF) at presentation in patients with TS.</p> <p>METHODS</p> <p>We analyzed 235 patients (mean age of 63.2±13.0 years, 90.0% females) with definitive diagnosis of TS, enrolled in a multicenter database. The patients were divided according to LVEF as assessed by transthoracic echocardiography within the first day after hospital admission into two groups: group 1 (LVEF ≤ 35%; 41.7%) and group 2 (LVEF > 35%; 58.3%). In hospital prevalence of acute heart failure and death in both groups were evaluated. Moreover the incidence of composite adverse events (death, stroke and recurrence of TS) was investigated at long term follow-up (median 23 months, IR range 10-56 months).</p> <p>RESULTS</p> <p>Compared with group 2, patients of group 1 had lower incidence of chest pain (84.8%% vs 94.1%%; p=0.019), higher prevalence of physical trigger (31.7% vs 15.3%; p=0.006) and more pronounced N-terminal pro-B type natriuretic peptide level (1716.9±1577.9 vs 1006.0±1262.2 pg/mL; p=0.007). In the acute phase, group 1 patients experienced more frequently acute heart failure symptoms (43.7% vs 19.1%; p<0.001) and a trend to higher rate of in-hospital mortality (4.2% vs 0.7%; p=0.094). At long follow-up the prevalence of cardiovascular events did not differ between both groups (composite adverse events: 8.2% vs 8.0%; p=0.662). The Kaplan-Meier analysis rates showed the absence of difference in long time follow-up (figure 1).</p> <p>CONCLUSION</p> <p>In this Portuguese population with definitive diagnosis of TS we found that echocardiographic evaluation of LVEF is crucial in the acute phase. Regardless of the severity of its acute episode, the systolic dysfunction at admission does not reflect higher cardiovascular risk at long term follow-up. The reversibility of this syndrome can explain our findings, however further studies are needed to establish the prognosis of patients with TS.</p>
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