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Can we predict in-hospital complications in Takotsubo Syndrome?
Session:
Sessão de Posters 32 - MINOCA
Speaker:
Marta Catarina Bernardo
Congress:
CPC 2024
Topic:
E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme:
13. Acute Coronary Syndromes
Subtheme:
13.7 Acute Coronary Syndromes - Other
Session Type:
Cartazes
FP Number:
---
Authors:
Marta Catarina Bernardo; Catarina Ribeiro Carvalho; Isabel Moreira; Luís Sousa Azevedo; Pedro Rocha Carvalho; Pedro Magalhães; Sofia Silva Carvalho; Ilídio Moreira
Abstract
<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><strong>Introduction:</strong> Takotsubo syndrome (TTS) is characterized by transient left ventricular systolic dysfunction in the absence of obstructive coronary disease. Several studies have demonstrated a substantial incidence of life-threatening complications in the acute phase of TTS, with mortality ranging from 1% to 8%.</span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><strong>Aim:</strong> To evaluate short term outcome and predictors of in-hospital complications in a population of patients (pts) admitted with TTS. </span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><strong>Methods: </strong>We performed a retrospective study of pts admitted to a single centre with diagnosis of TTS between 2008-2023. In-hospital complications included heart failure during hospitalization, stroke and death. We divided the pts into two groups: Group A- Pts who experienced complications during hospitalization, Group B- Pts without complications during hospitalization. </span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><strong>Results: </strong>We included 121 pts, mean age 71,0 ±12,3 years, 86,0% females. The median duration of hospital stay was 5,0 (IQR 3,5-7,0) days. 37,2% of the pts had in-hospital complications. Regarding cardiovascular risk factors, the two groups had similar rates of dyslipidemia (p= 0,33), hypertension (0= 0,29) and obesity (p= 0,28) with a higher prevalence of diabetes in group A (37,8% vs 19,7%, p= 0,03). No differences in the prevalence of chronic kidney disease (p= 0,92), previous heart failure (p= 0,89) or atrial fibrillation (p= 0,94). We observed more prevalence of psychiatric disease in group B (32,9% vs 8,9%, p= 0,003). </span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif">Concerning clinical presentation and electrocardiogram at admission we observed no differences between the groups, except for heart rate (88,0 (IQR 72-100) bpm in group A vs 78,0 (IQR 70,0-89,0) bpm in group B, p= 0,041). Group A had a significantly lower left ventricular ejection fraction (35,4% ±8,1 vs 44,3% ±11,2 p<0,005), presented more with right heart dysfunction (9,1% v 1,3%, p= 0,04) and with an echocardiographic pattern of “typical” TTS (97,7% vs 76,3%, p= 0,002). Analytically, group A had higher pro-BNP at admission (2204,5 (IQR 721,0-5085,8) pg/mL vs 5868,0 (IQR 2462,5-13613,3) pg/mL, p<0,005) and higher peak troponin (0,59 (IQR 0,32-0,99) ng/mL vs 0,35 (IQR 0,2-0,7) ng/mL, p= 0,015). The presence of concomitant coronary artery disease was higher in group A (34,2% vs 16,4%, p= 0,033). </span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif">In a <span style="font-family:CalibriRegular">mul</span>ti<span style="font-family:CalibriRegular">variate analysis, the typical type of TTS (HR 20,43, 95% CI 1,99-209,66, p= 0,011), heart rate (HR 1,02, 95% CI 1,002-1,005, p= 0,034) and troponin peak (HR 2,65, 95% CI 1,09- 6,44, p= 0,032) showed to be independent predictors of in-hospital complications.</span></span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif"><strong>Conclusions: </strong>The rates of in-hospital adverse cardiovascular events are not trivial in pts admitted with TTK, so it’s important to identify pts with high-risk characteristics at admission to allow intensive monitoring and careful follow-up of these pts.</span></span></p>
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