Echocardiographic parameters associated with in‐hospital adverse outcomes in patients with Takotsubo syndrome

Abstract

Introduction: Takotsubo syndrome (TTS) is an acute heart failure syndrome that leads to significant morbidity and mortality. We sought to evaluate the association of cardiac mechanics on presentation with in-hospital adverse outcomes in patients with apical TTS. Methods:We retrospectively identified 468 patients with TTS based on ICD-9/10 codes between 2006 and 2017. The association of echocardiographic parameters with a composite outcome of heart failure and all-cause mortality during the index hospitalization was analyzed. Results:One hundred and forty one patients with the apical subtype and adequate imaging were included. 113 (80.1%) were female, left ventricular ejection fraction (LVEF) was 41.7% ± 12.4%, and global longitudinal strain was −10.1% ± 3.2%. The composite outcome occurred in 58 patients (41%), with heart failure occurring in 55 patients and death occurring in nine patients. Global longitudinal strain, global circumferential strain, global radial strain, right ventricular fractional area change, tricuspid annular plane systolic excursion, and right ventricular free wall strain were significantly worse in patients who experienced the composite outcome in univariate analyses. However, only LVEF was independently associated with the composite outcome in multivariable-adjusted analysis. Conclusions:In patients with apical TTS, the strain has limited prognostic utility in the acute setting compared to LVEF, which was the only echocardiographic parameter associated with in-hospital heart failure and all-cause mortality.

Echocardiographic correlates of major adverse cardiac events at 1 year in patients with apical ballooning takotsubo syndrome

“…8,9 Strain is a sensitive marker of myocardial deformation that provides useful diagnostic and prognostic information in a growing number of clinical settings, including ischemic heart disease, cardiomyopathies, valvular disease, and cardio-oncology. 8,10 Case series and small cohort studies suggest strain is abnormal at presentation and abnormalities persist at follow-up in TTS patients [11][12][13][14][15] ; however, the prognostic utility of strain for long-term outcomes in TTS remains poorly understood. We sought to characterize changes in myocardial strain from baseline to follow-up echocardiogram to determine the association of change in strain measurements with adverse clinical outcomes within 1 year in TTS patients.…”