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Does QT interval prolongation have prognostic implications in Takotsubo Syndrome?
Session:
Posters (Sessão 3 - Écran 4) - Morte súbita cardíaca
Speaker:
Ana Isabel Pinho
Congress:
CPC 2023
Topic:
C. Arrhythmias and Device Therapy
Theme:
08. Ventricular Arrhythmias and Sudden Cardiac Death (SCD)
Subtheme:
08.7 Ventricular Arrhythmias and SCD - 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: Takotsubo Syndrome (TTS) has been linked with repolarization abnormalities including QT interval prolongation and acquired long QT syndrome. However, the association between QT prolongation and clinical outcomes in patients (pts) with TTS remains not fully understood. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Aim: Our objective was to investigate the association between prolonged corrected QT (QTc) interval during TTS events and in-hospital complications plus long-term prognosis.</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Methods: 111 TTS pts from a retrospective cohort admitted to our hospital were enrolled. The pts were assigned into a long QTc group or a normal QTc group according to the QT evolution on ECG during hospitalization. Long-term mortality and MACCE (composite of recurrence, acute coronary syndrome, heart failure, arrhythmias, stroke and death) were reported using Kaplan-Meier plots. </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Results: QTc prolongation was found in 43 pts (39%). Main demographic characteristics were similar between the two groups, as no age (66.7±12.9 years vs 68.1±10.9 years, P=0.532) or gender (93% vs 96% women, P=0.672) differences were observed between TTS pts with and without QTc prolongation. Prevalence of cardiovascular risk factors and other comorbidities was comparable; the exception was history of atrial fibrillation, which was more common in the prolonged QTc group (12% vs 1%, p=0.029).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">No differences were observed regarding the median duration of hospitalization (p=0.418), precipitating trigger (p=0.560), brain natriuretic peptide and troponin I peak levels (p=0.740 and p=0.645, respectively) and left ventricular systolic dysfunction (p=0.338).</span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Syncope was more prevalent in the prolonged QTc group, and typical chest pain was more frequent in the normal QTc group (p=0.004). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">In-hospital complications were comparable between TTS pts with and without prolonged QTc (49% vs 44%, p=0.637), including death (p=0.381) and arrhythmic complications like ventricular arrhythmias (p=0.556), atrial fibrillation (p=0.708) and complete atrioventricular block (p=0.556). </span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">Mean follow-up time of the cohort was 4.8±3.8 years. During long-term follow-up, the composite rate of MACCE was similar between the group with prolonged QTc during TTS event and the group with normal QTc. 5-year survival analysis showed no differences in all-cause mortality between the groups (p=0.51, figure 1). </span></span></p> <p><span style="font-size:11.0pt"><span style="font-family:"Calibri",sans-serif">Conclusion: Long QT interval is usually a frightening feature on ECG because of the increased risk of life-threatening cardiac arrhythmias. In our study, QT interval prolongation in TTS events had no prognostic implications during hospitalization and follow-up. More studies are needed to fully clarify if a prolonged QT interval during TTS is a transitory alteration with no prognostic role or a marker of acute and future complications. </span></span></p>
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