SPC365

Takotsubo syndrome – is the typical type the real villain?

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; Catarina Ferreira; Fernando Gonçalves; Pedro Magalhães; José Paulo Fontes; Ilídio Moreira

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><strong><span style="color:#212529">Background:</span></strong>&nbsp;<span style="color:black">Takotsubo syndrome (TTS) is an acute cardiac entity with clinical manifestations similar to myocardial infarction</span><span style="color:#212529">. Clinical differences in individuals presenting with either the typical (apical) or atypical (midventricular, basal, and focal) localization of left ventricular contraction abnormalities are not well understood.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><strong><span style="color:#212529">Methods:</span></strong><span style="color:#212529">&nbsp;Retrospective study with patients discharged from a single center with the diagnosis of TTS from January/2013 to November/2022. Two TTS groups were made based on typical or atypical left ventricular contraction patterns and were then compared regarding sex, clinical presentation, event trigger, and coronary artery disease. D</span><span style="color:black">uring follow-up, the primary outcome evaluated<span style="background-color:white"> was a composite of cardiovascular mortality, heart failure hospitalizations, stroke and TTS recurrence (MACCE).</span></span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><strong><span style="color:#212529">Results:</span></strong><span style="color:#212529">&nbsp;A total of 103 patients were included, 86 (84%) with the typical pattern and 16 (16%) with an atypical pattern (8 with the midventricular type, 3 with the basal type, and 5 with focal type). There was no difference in sex distribution (female: typical 86.4% vs atypical 75% p=0.154). <span style="background-color:white">Both groups had similar age (71&plusmn;11 vs 69&plusmn;13 years, p=0.513), cardiovascular risk factors, ST-segment elevation on admission (40% vs 43.8%, p=0.779), </span></span><span style="color:black">and peak T troponin [0.44 (IQR [0.22;0.73]) vs 0,54 IQR [0.30;0.73]), p=0.10]. However, patients with typical pattern had higher NT-</span><span style="background-color:white"><span style="color:#212529">pro-BNP levels on admission [3613</span></span><span style="color:black"> [IQR 1578;7167 mg/dl] vs 544 [IQR 544;3333 mg/dl], p = 0.023] and lower left ventricular ejection fraction on admission (LVEF) (37% vs 55%, p&lt;0.001) and on discharge (50% vs 58%, p=0.018).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="color:#212529">Trigger identification was similar (67% vs atypical 57%; p=0.659). Non-significant coronary artery stenosis &gt;50% was uncommon (typical TTS 21% vs atypical TTS 20%; p=0.934).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="color:#212529">Patients with a typical pattern had a higher incidence of acute heart failure (41.9% vs 6.3%; p=0.007), however, there was no statistical difference in the incidence of cardiogenic shock (9.3% vs 6.3%; p=0.693) or in-hospital mortality (4.7% vs 0%; p=0.379).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="color:black">During a median follow-up of 41 months [IQR 14;59], 23 patients (24.3%) <span style="background-color:white">experienced a MACCE event. The a</span></span><span style="color:#212529">djusted Cox regression analysis didn&rsquo;t show a significantly higher risk for MACCE in patients with typical TTS (adjusted HR: 2.07; 95% CI: 0.47 to 9.7, p=0.333).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><strong><span style="color:#212529">Conclusion:</span></strong></span></span></p>

<p style="text-align:justify"><span style="font-size:12pt"><span style="background-color:white"><span style="color:#212529">While an apical contraction anomaly is the most common type of presentation in TTS, atypical contraction patterns are found in 16% of the patients. Patients with typical pattern had a higher incidence of in-hospital complications, however both patterns had similar outcomes during follow-up.</span></span></span></p>