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Takotsubo Syndrome - different triggers in different populations?
Session:
Posters (Sessão 2 - Écran 5) - Doenças do miocárdio
Speaker:
Ana Isabel Pinho
Congress:
CPC 2023
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:
Ana Isabel Pinho; Luís Daniel Santos; Cátia Oliveira; Catarina Amaral Marques; André Cabrita; Ana Filipa Amador; Catarina Martins da Costa; João Calvão; Miguel Martins de Carvalho; Ricardo Alves Pinto; Tânia Proença; Paula Dias; Gonçalo Pestana; Carla Sousa; Filipe Macedo
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Background: Previously believed to be a self-limiting and benign condition related to stressful triggers, Takotsubo Syndrome (TTS) has been increasingly recognized as a much more heterogeneous entity. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Aim: To explore differences in demography and clinical characteristics among patients (pts) with TTS related to emotional and physical triggers and compare outcomes. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: A retrospective cohort of 142 TTS pts admitted to our hospital, defined according to the revised Mayo Clinic diagnostic criteria, was collected. The baseline characteristics of these pts and the occurrences during hospitalization were analyzed. Kaplan-Meier survival analysis was used to assess long-term mortality and MACCE (composite of recurrence, acute coronary syndrome, heart failure, arrhythmias, stroke and death). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: A stressful trigger was identified in 111 (78%) pts. In 65%, TTS was triggered by emotional stressors and, in 35%, by physical factors. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The prevalence of males was significant higher in the TTS group related to physical stress (23% versus 1%, p<0.01). In TTS related to physical stress, we found a greater frequency of neurologic diseases (33% vs 13%, p=0.009) and a lower percentage of overweight (18% vs 40%, p=0.016). Prevalence of other cardiovascular risk factors and psychiatric disorders were similar between the 2 groups (p=0.616 and p=0.444, respectively). No age differences were observed among the groups (p=0.502). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Typical chest pain was more frequent in the emotional stress group, whereas dyspnea and syncope were more common in the physical stress group (p<0.001). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Pts with TTS related to physical stress presented higher Killip class (p<0.001), with signs and symptoms of congestive heart disease in 62% (vs 26%) and a greater proportion of severe left ventricular dysfunction on admission (46% vs 26%, p=0.035). This group had a longer hospital stay (9 days, IQR 11 vs 6 days, IQR 17, p<0.001), and a higher rate of in-hospital complications (69% vs 32%, p<0.001). We found no difference in the incidence of death during hospitalization between groups (5% for physical triggers vs 1% for emotional triggers, p=0.282). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Comparison of mortality and MACCE at 10 years showed a slight trend towards a worse prognosis in the TTS group related to physical stress without statistically significance (figure 1). </span></span></p> <p style="text-align:justify"><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion: Pts with TTS triggered by physical stress were more often males, had more neurologic comorbidities, presented with more severe systolic dysfunction, dyspnea and syncope and had more intra-hospital complications than pts with TTS triggered by emotional stress. Our study supports the idea that under the general entity of TTS, there could be different clinical and demographic profiles. Therefore, our results question the traditional perception of TTS as a commonly benign entity.</span></span></p>
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