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Eur Heart J Acute Cardiovasc Care. 2016 Aug;5(4):308-16. doi: 10.1177/2048872615589512. Epub 2015 Jun 4.

Secondary forms of Takotsubo cardiomyopathy: A whole different prognosis.

Author information

1
Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid ibnsky@yahoo.es.
2
Servicio de Cardiología, H Virgen de la Macarena, Sevilla.
3
Servicio de Cardiología, H Vall d'Hebron, Barcelona.
4
Unidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital de Sant Pau, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona.
5
Servicio de Cardiología, H Universitario de Salamanca.
6
Servicio de Cardiología, H de la Princesa, Madrid.
7
Servicio de Cardiología, Complejo Hospitalario Universitario de Albacete.
8
Servicio de Cardiología, H Clínico Lozano Blesa, Zaragoza.
9
Servicio de Cardiología, H Universitario Arnau de Vilanova, Lérida.
10
Servicio de Cardiología, H Universitario de Canarias, Tenerife.
11
Servicio de Cardiología, Consorcio Hospital General Universitario de Valencia, Valencia.
12
Servicio de Cardiología, Hospital Carlos Haya, Málaga.
13
Servicio de Cardiología, Hospital Puerta de Hierro, Majadahonda, Madrid.
14
Servicio de Cardiología, Hospital Fundación Jiménez Díaz, Madrid.
15
Servicio de Cardiología, Hospital General Universitario Gregorio Marañón, Madrid.
16
Servicio de Cardiología, Hospital Universitario GermansTrias i Pujol, Badalona, Barcelona.
17
Servicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago de Compostela.
18
Servicio de Cardiología, Hospital General Universitario de Ciudad Real, Ciudad Real.
19
Servicio de Cardiología, Hospital Da Costa, Burela, Lugo.
20
Servicio de Cardiología, Hospital Clínico Universitario de Valencia, Valencia.
21
Servicio de Cardiología, Hospital de Manacor, Mallorca.
22
Instituto Cardiovascular, Hospital Clínico San Carlos, Madrid.

Abstract

BACKGROUND:

Takotsubo syndrome (TKS) usually mimics an acute coronary syndrome. However, several clinical forms have been reported. Our aim was to assess if different stressful triggers had prognostic influence on TKS, and to establish a working classification.

METHODS:

We performed an analysis including patients with TKS between 2003-2013 from our prospective local database and the RETAKO National Registry, fulfilling Mayo criteria. Patients were divided in two groups regarding their potential triggers: (a) none/psychic stress as 'primary forms' and (b) physical factors (asthma, surgery, trauma, etc.) as 'secondary forms'.

RESULTS:

Finally, 328 patients were included, 90.2% women, with a mean age of 69.7 years. Patients were divided into primary TKS (n=265) and 63 secondary TKS groups. Age, gender, previous functional class and cardiovascular risk profile displayed no differences between groups before admission. However, primary-TKS patients suffered a main complaint of chest pain (89.4% vs 50.7%, p<0.0001) with frequent vegetative symptoms. Regarding treatment before admission, there were no differences either. During admission, differences were related to more intensive antithrombotic and anxiolytic drug use in the primary TKS group. Inotropic and mechanical ventilation use was higher in the secondary cohort. After discharge, a more frequent prescription of beta-blockers and statins in primary-TKS patients was seen. Secondary forms displayed more in-hospital stay and evolutive complications: death (hazard ratio (HR): 3.41; 95% confidence interval (CI): 1.14-10.16, p=0.02), combined event variable (MACE) (HR: 1.61; 95% CI: 1.01-2.6, p=0.04) and recurrences (HR: 1.85; 95% CI: 1.06-3.22, p=0.02).

CONCLUSION:

Secondary TKS could present or mark worse short and long-term prognoses in terms of mortality, recurrences and readmissions. We propose a simple working nomenclature for TKS.

KEYWORDS:

RETAKO; Takotsubo syndrome; classification; nomenclature; prognosis; secondary

PMID:
26045512
DOI:
10.1177/2048872615589512
[Indexed for MEDLINE]

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