SPC365

Takotsubo syndrome - does trigger matter?

Session: Posters (Sessão 5 - Écran 7) - Miocardiopatia de stress
Speaker: Pedro Rocha Carvalho

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: Pedro Rocha Carvalho; Isabel Moreira; Marta Catarina Bernardo; Catarina Carvalho; Fernando Gonçalves; Pedro Magalhães; José Paulo Fontes; Ilídio Moreira

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Introduction</strong>: Takotsubo syndrome (TTS) is an acute cardiac entity usually triggered by physical or emotional stress associated with a catecholamine storm, overactivity of sympathetic nerves, or microvascular dysfunction in the setting of systemic inflammation. However,<span style="background-color:white"><span style="color:#212121"> sometimes no trigger is identified.</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Purpose</strong>: To investigate if TTS triggers <span style="background-color:white"><span style="color:black">are associated with worse long-term cardiovascular prognosis</span></span>. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Methods</strong>: Retrospective study with patients discharged with the diagnosis of TTS in a single center from January/2013 to November/2022. Patients were divided into 3 groups: physical trigger, emotional trigger&nbsp;and no trigger identified. During follow-up, the primary outcome was a <span style="background-color:white"><span style="color:black">composite of heart failure hospitalization, death, stroke&nbsp;and TTS recurrence (MACCE).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong>Results</strong>: A total of<span style="background-color:white"><span style="color:#212529"> 103 patients were included (85,7% females; mean age 71&plusmn;12 years old), 84,8% presenting with chest pain, and 41,2% presenting with ST-segment elevation on electrocardiogram. There was an identifiable trigger in 69 patients (34 had an emotional and 35 had a physical trigger).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">The 3 study groups (without trigger vs emotional trigger vs physical trigger) had similar baseline characteristics which included age (71&plusmn;12 vs 68&plusmn;12 vs 72&plusmn;13 years, p=0,121), cardiovascular risk factors, and neurological or psychiatric illness. </span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">When compared with physical trigger, patients with emotional trigger were less likely to present ST-segment elevation (51,3% vs 26,5% vs 45,4%, p=0,091) or with acute pulmonary oedema (8,6% vs 0% vs 11,4%, p=0,1), but were more likely to present with chest pain (94,3% vs 94,1% vs 68,6%, p=0,013).</span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="background-color:white"><span style="color:#212529">During hospitalization, patients with physical trigger had a higher incidence of heart failure (25,7% in patients without trigger vs 36,1% emotional trigger vs 47,1%, p= 0,101), cardiogenic shock (8,6% in patients without trigger vs 2,9% emotional trigger vs 14,7%, p= 0,211) and need of mechanical ventilation (14,3% in patients without trigger vs 2,9% emotional trigger vs 24,2%, p= 0,04).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif">During a median follow-up of 41 months (IQR:35;55), 37 patients (38,5%) <span style="background-color:white"><span style="color:black">experienced a MACCE event</span></span>. In a multivariate regression analysis, after adjusting for possible confounders, the physical trigger group had a higher risk of MACCE (HR 2,675, 95% CI: 1.130-6.33, p=0,025) than the other two groups. If we compare only the emotional and physical trigger groups, the latter had a 3 times higher risk of MACCE (HR 2,99, 95% CI: 1.20-7,49, p=0,019). No statistically significant difference was noted in MACCE between patients with an emotional trigger and patients without <span style="background-color:white"><span style="color:#212529">an identifiable trigger</span></span>.</span></span></p>

<p><strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">Conclusions</span></span></strong><span style="font-size:11.0pt"><span style="font-family:&quot;Calibri&quot;,sans-serif">: <span style="background-color:white"><span style="color:#212529">Patients with TTS induced by physical triggers have a significantly worse prognosis. </span></span>The physical trigger group had a 3 times higher risk of MACCE than the emotional trigger group, and because of this, higher vigilance of these patients is needed. </span></span></p>