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Clinical characterization and long-term follow-up of patients with Takotsubo Syndrome: 18-year experience of a Portuguese tertiary care center
Session:
Posters (Sessão 5 - Écran 7) - Miocardiopatia de stress
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; Cátia Oliveira; Luís Daniel Santos; André Cabrita; Catarina Amaral Marques; 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:16px"><span style="font-family:Calibri,sans-serif">Background: Takotsubo Syndrome (TTS) is characterized by transient acute systolic dysfunction, traditionally preceded by a trigger. Etiology and pathophysiology remain unclear, and TTS can manifest in a wide spectrum of severity with variable morbidity and mortality rates. </span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">Aim: To characterize the TTS population admitted in a tertiary center and evaluate long-term follow-up.</span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">Methods: A retrospective cohort of TTS patients admitted to our hospital between June 2005 and November 2022 was collected. TTS was defined according to the revised Mayo Clinic diagnostic criteria. A composite of major adverse cardiac and cerebrovascular events (MACCE), including recurrence, acute coronary syndrome, heart failure, stroke, arrhythmias and death, was defined.</span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">Results: 142 TTS patients were included; mean age was 67.2±12.3 years; 8% were males. Hypertension was the most common comorbidity (68%), followed by dyslipidaemia (52%) and psychiatric disorders (45%). A precipitating factor was found in 78%. The most frequent symptom at admission was chest pain (70%). 40% of cases were admitted in Killip class≥II.</span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">The initial ECG commonly showed T-wave inversion (38%) or ST-segment elevation (31%); 30% had QT-interval prolongation. 30% had an InterTak score value ≥72 points (probability of TTS >90%). </span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">The median of Troponin I peak levels was 1.73 (IQR 0.81-3.42) ng/mL, and of brain natriuretic peptide levels was 318 (IQR 133-819) ng/mL.</span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">Left ventricle systolic dysfunction was present in 85%. 85% had apical akinesis while 7% showed midventricular and 1.4% basal variants. Coronary angiography (performed in 92%) revealed normal vessels in 65%, mild coronary atherosclerosis in 20% and non-obstructive lesions in 7%.</span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">Although most patients with TTS recover, the risk of in-hospital complications was 44% (table 1). In-hospital mortality was 2.1% and the risk of cardiovascular rehospitalization was 3.8% in the first 30 days. </span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">As for the long-term follow (mean 5.7±4.4 years), the composite rate of MACCE was 6.1% per patient-year and the rate of death from any cause was 2.1% per patient-year. Ten patients had TTS recurrence; the risk was 1.3% per patient-year and the mean time of recurrence was 44 months (2 - 137 months). </span></span></p> <p style="text-align:justify"><span style="font-size:16px"><span style="font-family:Calibri,sans-serif">Conclusion: TTS is now considered a much more heterogeneous and less benign condition than previously thought. During long-term follow-up, we found substantial rates of recurrence, death from any cause and MACCE. Our data emphasizes the importance of more research on risk factors and treatment for this condition.</span></span></p>
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