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Takotsubo syndrome: How to predict left ventricular dysfunction?
Session:
Posters 4 - Écran 4 - Doenças do Miocárdio
Speaker:
Nzinga Carolina Manuel André
Congress:
CPC 2019
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:
Nzinga André; Pedro Carilho Ferreira; João Pedro Ribeiro Agostinho; Joana Rigueira; Inês Aguiar Ricardo; Afonso Nunes Ferreira; Rafael Santos; Nelson P. Cunha; Tiago Graça Rodrigues; Pedro Silvério António; Fausto José Pinto
Abstract
<p><strong>Introduction</strong>: Takotsubo syndrome (TS) is a cardiomyopathy that clinically mimics an acute coronary syndrome and is often associated with physical or emotional stress. Although it is an usually benign condition, it may be associated with significant ventricular dysfunction, so it is important to identify patients at higher risk.</p> <p><strong>Objective</strong>: To assess epidemiological and clinical characteristics of a population with TS and evaluation of variables associated with left ventricular dysfunction.</p> <p><strong>Methods</strong>: Retrospective, unicentric cohort study that included consecutive patients with TS diagnosis between January 2015 to December 2018. Demographic, clinical, electrocardiographic, echocardiographic, and laboratory data were collected. For statistical analysis, the chi-square test and the student T-test were used.</p> <p><strong>Results</strong>: A total of 54 patients (87% female, 67.4 ± 12 years) were included in the study with a mean InterTAK score of 58.5 ± 17 (68.6% with a score > 50; 18, 5% between 30-50 and 1.9% <30 points). The most frequent comorbidities were HTN 74.1%, diabetes 25.9%, dyslipidemia 46.3% and depressive syndrome 26.4%.</p> <p>The majority of women (87.8%) were in the postmenopausal period. Emotional stress was identified as a trigger factor in 57.4% of cases and physical stress in 38.9%. The mean hospitalization time was 9.5 ± 5.8 days. Of the electrocardiographic characteristics at admission, ST elevation was found in 50% of patients, ST deflection in 18.5% and inversion of T wave in 37%, mean QTc of 421 +/- 38 msec. Echocardiographic evaluation showed a mean left ventricular ejection fraction (LVEF) at admission of 47.8 +/- 10%, with 17 patients having LVEF < 40% (31.5%). The TS when preceded by physical stress was associated with a lower LVEF on admission (43.4 ± 9.8 vs 50.7 ± 9.4, p = 0.008). There was a tendency for the postmenopausal period being protective of the development of ventricular dysfunction (X<sup>2</sup> = 4.2, p = 0.041, OR = 0.16 CI 0.03-1.07), with no relation to anymore comorbidity. No ECG pattern was associated with ventricular dysfunction.</p> <p><strong>Conclusions</strong>: In this population, the presence of physical stress was more frequently associated with a compromised ventricular function, and the postmenopausal period appeared to be protective. The identification of ventricular dysfunction preditors may allow the identification of patients at higher risk and who benefit more rigorous monitoring.</p>
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