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J Am Heart Assoc. 2019 Nov 5;8(21):e011194. doi: 10.1161/JAHA.118.011194. Epub 2019 Nov 1.

Clinical Predictors and Prognostic Impact of Recovery of Wall Motion Abnormalities in Takotsubo Syndrome: Results From the International Takotsubo Registry.

Author information

1
University Heart Center Department of Cardiology University Hospital Zurich Zurich Switzerland.
2
Centro Cardiologico Monzino IRCCS Milan Italy.
3
Department of Cardiovascular Medicine Chiba University Graduate School of Medicine Chiba Japan.
4
Division of Cardiology Department of Medical Sciences AOU Città della Salute e della Scienza University of Turin Italy.
5
First Department of Cardiology Medical University of Gdansk Poland.
6
Heart Department University Hospital "San Giovanni di Dio e Ruggi d'Aragona" Salerno Italy.
7
University of Southern California, Keck School of Medicine Los Angeles CA.
8
Department of Cardiology and Angiology Hannover Medical School Hannover Germany.
9
Department of Cardiology Heidelberg University Hospital Heidelberg Germany.
10
Division of Cardiology, Angiology and Intensive Medical Care Department of Internal Medicine III University Hospital Halle Martin-Luther-University Halle Halle (Saale) Germany.
11
Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany.
12
Heart and Vascular Centre Bad Bevensen Bad Bevensen Germany.
13
Deutsches Herzzentrum München Technische Universität München Munich Germany.
14
DZHK (German Centre for Cardiovascular Research), Partner Site Munich Heart Alliance Munich Germany.
15
Department of Internal Medicine II-Cardiology University of Ulm, Medical Center Ulm Germany.
16
Department of Cardiology Charité, Campus Rudolf Virchow Berlin Germany.
17
TJ Health Partners Heart and Vascular Glasgow KY.
18
Department of Internal Medicine III Heart Center University of Cologne Germany.
19
Krankenhaus "Maria Hilf" Medizinische Klinik Stadtlohn Germany.
20
Clinic for Cardiology and Pneumology Georg August University Goettingen Goettingen Germany.
21
Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany.
22
DZHK (German Centre for Cardiovascular Research), Partner Site Hamburg/Kiel/Luebeck Hamburg Germany.
23
Service de cardiologie Hôpitaux Universitaires de Genève Geneva Switzerland.
24
Department of Cardiology John Radcliffe Hospital Oxford University Hospitals Oxford United Kingdom.
25
Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland.
26
Department of Cardiology Kantonsspital Winterthur Winterthur Switzerland.
27
Heart Center Turku University Hospital and University of Turku Turku Finland.
28
Department of Cardiology Kings College Hospital Kings Health Partners London United Kingdom.
29
Department of Cardiology University Hospital Basel Basel Switzerland.
30
Department of Cardiovascular Sciences Catholic University of the Sacred Heart Rome Rome Italy.
31
University Hospital for Internal Medicine III (Cardiology and Angiology) Medical University Innsbruck Innsbruck Austria.
32
Department of Cardiology Christchurch Hospital Christchurch New Zealand.
33
Department of Internal Medicine B University Medicine Greifswald Greifswald Germany.
34
DZHK (German Centre for Cardiovascular Research), Partner Site Greifswald Greifswald Germany.
35
Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France.
36
Charles University in Prague and University Hospital Kralovske Vinohrady Prague Czech Republic.
37
Department of Medicine College of Medicine University of Florida Gainesville FL.
38
Intensive Coronary Care Unit Moscow City Hospital # 1 named after N. Pirogov Moscow Russia.
39
First Department of Medicine Faculty of Medicine University Medical Centre Mannheim (UMM) University of Heidelberg Mannheim Germany.
40
DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim Mannheim Germany.
41
Department of Internal Medicine I - Cardiology University Hospital Olomouc Olomouc Czech Republic.
42
Klinik für Innere Medizin III Universitätsklinikum des Saarlandes Homburg/Saar Germany.
43
Advanced Heart Failure and Transplantation Center University Medical Center Ljubljana Ljubljana Slovenia.
44
Local Health Unit n.8, Cardiology Unit Arzignano Vicenza Italy.
45
Cardiology Department Santa Maria University Hospital (CHLN) Lisbon Academic Medical Centre and Cardiovascular Centre of the University of Lisbon (CCUL) Lisbon School of Medicine Universidade de Lisboa Portugal.
46
Department of Cardiology Medical University of Warsaw Poland.
47
Division of Cardiovascular Diseases Mayo Clinic Rochester MN.
48
Department of Cardiology Basil Hetzel Institute Queen Elizabeth Hospital University of Adelaide Australia.
49
University Hospital Careggi Florence Italy.
50
Fondazione Policlinico Universitario A. Gemelli IRCCS Roma Italy.
51
DZHK (German Center for Cardiovascular Research), Partner Site Berlin Berlin Germany.
52
Berlin Institute of Health (BIH) Berlin Germany.
53
Internal Medicine/Cardiology, Angiology, and Pneumology Magdeburg University Magdeburg Germany.
54
Department of Internal Medicine/Cardiology Heart Center Leipzig-University Hospital Leipzig Germany.
55
Department of Cardiology Leiden University Medical Centre Leiden The Netherlands.
56
Center for Molecular Cardiology Schlieren Campus University of Zurich Switzerland.
57
Cardiology Royal Brompton and Harefield Hospitals Trust and Imperial College London United Kingdom.

Abstract

Background Left ventricular (LV) recovery in takotsubo syndrome (TTS) occurs over a wide-ranging interval, varying from hours to weeks. We sought to investigate the clinical predictors and prognostic impact of recovery time for TTS patients. Methods and Results TTS patients from the International Takotsubo Registry were included in this study. Cut-off for early LV recovery was determined to be 10 days after the acute event. Multivariable logistic regression was used to assess factors associated with the absence of early recovery. In-hospital outcomes and 1-year mortality were compared for patients with versus without early recovery. We analyzed 406 patients with comprehensive and serial imaging data regarding time to recovery. Of these, 191 (47.0%) had early LV recovery and 215 (53.0%) demonstrated late LV improvement. Patients without early recovery were more often male (12.6% versus 5.2%; P=0.011) and presented more frequently with typical TTS (76.3% versus 67.0%, P=0.040). Cardiac and inflammatory markers were higher in patients without early recovery than in those with early recovery. Patients without early recovery showed unfavorable 1-year outcome compared with patients with early recovery (P=0.003). On multiple logistic regression, male sex, LV ejection fraction <45%, and acute neurologic disorders were associated with the absence of early recovery. Conclusions TTS patients without early LV recovery have different clinical characteristics and less favorable 1-year outcome compared with patients with early recovery. The factors associated with the absence of early recovery included male sex, reduced LV ejection fraction, and acute neurologic events. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01947621.

KEYWORDS:

outcome; recovery; takotsubo syndrome; wall motion abnormalities

PMID:
31672100
DOI:
10.1161/JAHA.118.011194
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