Clinical profile and in-hospital outcome of Caucasian patients with takotsubo syndrome and right ventricular involvement. (15th September 2016)

• Record Type: Journal Article
• Authors: Citro, Rodolfo; Bossone, Eduardo; Parodi, Guido; Carerj, Scipione; Ciampi, Quirino; Provenza, Gennaro; Zito, Concetta; Prota, Costantina; Silverio, Angelo; Vriz, Olga; D'Andrea, Antonello; Galasso, Gennaro; Baldi, Cesare; Rigo, Fausto; Piepoli, Massimo; Salerno-Uriarte, Jorge; Piscione, Federico
• Is Part Of: International journal of cardiology. Volume 219(2016)
• Page Start: 455
• Page End: 461
• Publication Date: 2016-09-15
• Subjects: BNP brain natriuretic peptide -- CCI Charlson comorbidity index -- CI confidence interval -- COPD chronic obstructive pulmonary disease -- FAC fractional area change -- HR hazard ratio -- iLVEDV indexed LV end-diastolic volume -- iLVESV indexed LV end-systolic volume -- LV left ventricular -- LVEF left ventricular ejection fraction -- LVOTO left ventricular outflow tract obstruction -- MR mitral regurgitation -- RV right ventricular -- RVi right ventricular involvement -- sPAP systolic pulmonary artery pressure -- STE ST-segment elevation -- TAPSE tricuspid annular plane systolic excursion -- TIN Tako-tsubo Italian Network -- TR tricuspid regurgitation -- TTS Takotsubo syndrome -- WMSI wall motion score index; Takotsubo -- Right ventricle -- TAPSE -- sPAP; Cardiology -- Periodicals; Electronic journals; 616.12
• DOI: 10.1016/j.ijcard.2016.06.039
• Languages: English
• ISSNs: 0167-5273

Abstract

Abstract: Aim: To determine the prevalence, clinical characteristics, in-hospital course and determinants of major adverse events in a cohort of Caucasian patients with Takotsubo syndrome (TTS) and right ventricular involvement (RVi), regardless of left ventricular variant forms. Methods and results: The study population consisted of 424 patients (mean age 69.1 ± 11.5 years; female 92.2%) with a diagnosis of TTS divided into two groups according to the presence or absence of RVi. RVi patients (n = 57; 13.4%) showed a higher prevalence of comorbidities, especially respiratory diseases (p = 0.011), and a higher Charlson comorbidity index (CCI; p = 0.006) than non-RVi patients. In-hospital major adverse events (acute heart failure, cardiogenic shock and death) occurred more frequently in RVi patients (p < 0.001). Heart rate and CCI, along with the echocardiographic parameters of wall motion score index, E/e' ratio, tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP) were associated with adverse in-hospital outcome. At multivariate analysis, CCI (HR: 1.871; 95% CI: 1.202–2.912; p = 0.006), sPAP (HR: 1.059; 95% CI: 1.016–1.104; p = 0.007) and TAPSE (HR: 0.728; 95% CI: 0.619–0.855; p < 0.001) were independent correlates of the composite outcome in patients with RVi. Conclusion: Patients with RVi are characterized by distinct clinical profile and should undergo closely clinical and echocardiographic monitoring. The presence of echocardiographic signs of right ventricular failure along with substantial comorbidities burden identify a cohort at higher risk of in-hospital major adverse cardiovascular events.