SPC365

Takotsubo syndrome: ten-year experience from a single center

Session: Posters (Sessão 5 - Écran 3) - Doenças do Miocárdio e Pericárdio 2
Speaker: Carla Marques Pires

Congress: CPC 2022
Topic: F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme: 17. Myocardial Disease
Subtheme: 17.7 Myocardial Disease - Other
Session Type: Pósters Electrónicos
FP Number: ---
Authors: Carla Marques Pires; Barbára Pontes; Paulo Medeiros; Rui Flores; Fernando Mané; Cátia Oliveira; Rodrigo Silva; Inês Conde; António Gaspar; Pedro Azevedo; Miguel Alvares Pereira; Carlos Galvão Braga; Nuno Antunes; Jorge Marques

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>INTRODUCTION</strong>: Takotsubo Syndrome (TS) is characterized by a transient left ventricular dysfunction and remains a challenging and often misdiagnosed disorder. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Previously, TS has been considered a benign disease, although current knowledge challenges this assumption.</span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>AIM</strong>: To characterize the population admitted with TS and to assess the predictors of worst in-hospital outcomes.</span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>METHODS</strong>: We performed a retrospective observational cohort study including 176 patients (pts) with the presumptive diagnosis of TS admitted at a single center over a 10-year period with at least one-year follow-up. 46 pts were excluded because TS was not confirmed.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">By multivariate analysis, we evaluate the predictors of admission Killip&ge;III and in-hospital complications (a composite of all-cause of death, ventricular arrhythmias/cardiac arrest, new-onset atrial fibrillation, atrioventricular block, mechanical complications, left ventricle thrombus and major bleeding).</span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">&nbsp;<strong>RESULTS</strong>: </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The study population consisted of 130 pts (90% female, mean age 66 years), of whom 89% had at least one Cardiovascular risk factor and 36% had psychiatric disorders. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The trigger event was emotional stress in 36%, physical stress in 19% and unidentifiable in 45%.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The median ejection fraction (EF) at admission was 38%; 82% of TS pts displayed an apical ballooning (AB) pattern (Typical TS). Regarding clinical presentation, 12% had Killip&ge;III at admission.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Over time, there was a trend to a increase in the number of pts diagnosed with atypical TS, although this was not statistically significant. Patients with atypical TS were younger (60&plusmn;14 vs 67&plusmn;11, p=0.009) and had higher admission EF (45%&plusmn; 8 vs 38%&plusmn;9, p=0.006). The trigger event and the level of PNBP were similar across different variants.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">A significant increase use of CMR was observed over the years (p=0.001). </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During hospitalization, 98.5% of pts were treated with at least one disease modifying drug, around 19.2% of pts had at least 1 in-hospital complication and 1.5% died.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In the multivariate analysis, left ventricular systolic dysfunction at admission (OR=3.2, p=0.019) and higher grades of mitral regurgitation (OR=2.2, p=0.02) were independent predictors of Killip&ge;III at admission.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Additionally, history of atrial fibrillation (OR=17.1, p=0.002), maximum Killip class during hospitalization (OR=3, p&lt;0.001) and the in-hospital usage of beta-blockers (OR=0.2, p=0.03) were independent predictors of in-hospital complications.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During follow-up, 1,5% of pts had recurrence and 11.5% died.</span></span></p>

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<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>CONCLUSION</strong>: </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Despite increased awareness TS is still poorly recognized, namely atypical variants which were younger and with higher admission EF.</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">TS is not as benign as initial though and the independent predictors of in-hospital complications were previous atrial fibrillation and maximum Killip class. In-hospital usage of beta-blockers had a protective effect.</span></span></p>

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