Coincidental coronary artery disease impairs outcome in patients with takotsubo cardiomyopathy

Bill, Verena; El‐Battrawy, Ibrahim; Schramm, Katja; Ansari, Uzair; Hoffmann, Ursula; Haghi, Dariush; Kuschyk, Juergen; Borggrefe, Martin; Akın, İbrahim

doi:10.1093/qjmed/hcx035

Cited by 20 publications

(15 citation statements)

References 23 publications

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“…In contrast to the initial view that TS and obstructive CAD are contradictory, available data suggest that CAD is not rare in TS patients (. Table 3; [57][58][59][60][61][62]). However, published studies on CAD and TS are rather small, especially the investigated cohorts of patients with TS and coexisting obstructive CAD.…”

Section: Coexisting Coronary Artery Diseasementioning

confidence: 99%

Takotsubo syndrome: between evidence, myths, and misunderstandings

Napp

Bauersachs

2020

Herz

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Takotsubo syndrome (TS) is an acute cardiac condition characterized by transient wall motion abnormalities mostly of the left ventricle. First described in 1990, TS has gained substantial attention during the past 15 years. However, the disease is still underdiagnosed. Prospective studies on TS are largely lacking, and the condition remains incompletely understood. In addition, significant misconceptions and misunderstandings are evident, contributing to potentially severe underestimation. Here, we review important aspects of TS with a focus on pitfalls, misinterpretations, and knowledge gaps considered important during diagnosis and management of the disease.

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Section: Coexisting Coronary Artery Diseasementioning

confidence: 99%

Takotsubo syndrome: between evidence, myths, and misunderstandings

Napp

Bauersachs

2020

Herz

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“…37 It remains especially important to recognize the presence of CAD in TTS as it is associated with poor outcomes. In Bill et al (2017), CAD in TTS patients had significantly lower EF, higher risk of cardiogenic shock was an independent predictor of mortality when compared to non-CAD TTS patients. 36 In 2016, the European Society of Cardiology recognized CAD as a risk factor for more severe heart failure during acute TTS episodes.…”

Section: Discussionmentioning

confidence: 78%

“…The Mayo Clinic criteria indicate that the absence of obstructive CAD is still possible with a diagnosis of TTS, and previous studies have reported non-CAD levels in up to 19% of TTS patients. 5,18,36,37 Modern techniques such as fractional flow reserve and intravascular ultrasound have now provided objective measurements to evaluate potential obstructive lesions to help delineate TTS from obstructive CAD. Parodi et al (2013) stated that TTS and CAD were not mutually exclusive and up to 10% of TTS patients may have been missed due to their exclusion of patients with documented CAD.…”

Section: Discussionmentioning

confidence: 99%

Observed Clinical, Laboratory, and Echocardiographic Parameters in Takotsubo Syndrome Patients with Mortality and Decreased Ejection Fraction During Initial Hospital Admission

Hinojos

Vanhecke

Manning

2018

Spartan Medical Research Journal

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CONTEXT CONTEXT Approximately 1-2% of patients with suspected acute coronary syndrome also develop Takotsubo syndrome (TTS). This syndrome is characterized by transient systolic dysfunction of the apical and/or mid segments of the left ventricle that mimics myocardial infarction in the absence of obstructive coronary artery disease. Up to 21.8% of TTS patients develop serious complications, including death. Currently, there is no consensus on management of these patients and their complications. Thus, identifying TTS patients at higher risk for complications becomes valuable in managing their hospital course. The aim of this study was to examine the predictive significance of laboratory, echocardiographic, and clinical parameters on in-hospital mortality in a sample subgroup of TTS patients. Secondary analyses were performed on patients with reduced (i.e., <35%) ejection fractions. METHODS METHODS This retrospective study at a community hospital identified patients from October 1, 2009 to August 31, 2015 who presented with ACS and underwent cardiac catheterization. Patients were diagnosed with TTS by features of cardiomyopathy on cardiac catheterization or echocardiogram. RESULTS RESULTS The authors analyzed data from a total of 177 eligible patients identified with TTS. The in-hospital mortality rate was 5.65%. Compared to the non-mortality subgroup, patients who suffered in-hospital mortality had significantly lower diastolic blood pressure on admission (p < 0.050), lower hemoglobin levels (p < 0.001), lower sodium (p = 0.020), higher blood urea nitrogen (p = 0.009), lower glomerular filtration rate (p = 0.016), and lower albumin levels (p < 0.001). Cox regression analyses demonstrated admission hemoglobin was significant, yielding a mortality hazard ratio of 0.760 (95% CI of 0.594-0.972, p = 0.029). CONCLUSIONS CONCLUSIONS Patients who present with TTS and hypotension, anemia, low albumin levels, elevated lactic acid and renal dysfunction were associated with higher rates of in-hospital mortality in this study's sample population. Further, admission hemoglobin had the strongest association with death. Every unit decrease in hemoglobin increased mortality risk by 24%.

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“…27 Furthermore, in a 2-year follow-up, concomitant coronary artery disease (CAD) complicated their outcome leading to raised mortality compared with TC without CAD. 28 In a recent study, El-Battrawy et al showed higher rates of in-hospital events and mortality in the patients with TC having atrial fibrillation (AF) compared with patients with TC without AF. 29 Bill et al, 30 in this issue of Angiology , observed that patients with TC and kidney failure (KF), compared with patients with TC without KF, have a worse prognosis.…”

Section: Comorbidity and Prognosismentioning

confidence: 99%