Evaluation of therapy management and outcome in Takotsubo syndrome

Abstract

BackgroundTo date there is no validated evidence for standardized treatment of patients with Takotsubo syndrome (TTS). Medication therapy after final TTS diagnosis remains unclear. Previous data on patient outcome is ambivalent. Aim of this study was to evaluate medication therapy in TTS and to analyze patient outcome.MethodsWithin an observational retrospective cohort study we analyzed our medical records and included 72 patients with TTS that underwent cardiovascular magnetic resonance imaging (CMR) after a median of 2 days interquartile range (IQR 1–3.5). We investigated medication therapy at discharge. Medication implementation and major adverse clinical events (MACE) were prospectively evaluated after a median follow-up of 24 months (IQR 6–43). Left ventricular function, myocardial oedema and late gadolinium enhancement were analyzed in a CMR follow-up if available.ResultsAntithrombotic therapy was recommended in 69 (96%) patients including different combinations. Antiplatelet monotherapy was prescribed in 28 (39%) patients. Dual antiplatelet therapy was recommended in 29 (40%) patients. Length of therapy duration varied from one to twelve months. Only in one case oral anticoagulation was prescribed due to apical ballooning with a left ventricular ejection fraction <30%. In all other cases oral anticoagulation was recommended due to other indications. ß-adrenoceptor antagonists and ACE inhibitors were recommended in 63 (88%), mineralocorticoid receptor antagonists were prescribed in 31 (43%) patients. After a median of 2 months (IQR 1.3–2.9) left ventricular function significantly recovered (49.1% ± 10.1 vs. 64.1% ± 5.7, P < 0.001) and myocardial oedema significantly decreased (13.5 ± 11.3 vs. 0.6% ± 2.4, P = <0.001) in the CMR follow-up. The 30-day mortality was 1%. MACE rate after 24 months was 12%.ConclusionAlthough therapy guidelines for TTS currently do not exist, we found that the majority of patients were treated with antithrombotic and heart failure therapy for up to twelve months. Left ventricular function and myocardial oedema recovered rapidly within the first two months. Outcome analysis showed a low bleeding rate and a high short-term survival. Therefore, TTS patients might benefit from antithrombotic and heart failure therapy at least for the first two months.

Takotsubo cardiomyopathy in the intensive care unit

“…reported that treatment with antithrombotics and cardiac failure therapy within the first 2 months was achieved without the risk of bleeding and that the short‐term survival rate was high. They also reported that aspirin, oral anticoagulation, and low molecular weight heparin (among other therapies) were used for antithrombotic therapy . The selection of these medications was not clearly determined.…”

Management of Takotsubo Syndrome: A Comprehensive Review

“…A total of 4,313 articles were found of which 248 articles met the inclusion criteria. Based on predefined criteria, only 16 of these articles were included in this review ( Table 1) [5][6][7][8][9][10][11][12][13][14][15][16][17][18][19][20].…”

“…A Mayo clinic study failed to show any survival benefits of ACE inhibitors and beta-blockers in TTS patients [38]. An observation study by Abanador-Kamper et al reviewed all the treatment regimens for TTS patients and concluded that the benefits of heart failure cocktail medications and antithrombotic therapy is highest during the first two months of TTS, with a low side effect profile, high survival, and early recovery [11]. A case series study by Santoro et al concluded that the use of levosimendan can improve the LV ejection fraction and has a good safety profile [18].…”

Infarto agudo de miocardio sin enfermedad coronaria ateroesclerótica obstructiva

“…En ausencia de un consenso respecto a los criterios diagnósticos, en el año 2004, investigadores de la clínica Mayo propusieron cuatro criterios con el propósito de distinguir esta enfermedad de otras entidades como los SCA. Durante la fase aguda y subaguda, se pueden ver cambios electrocardiográficos como la elevación del ST, siendo este el más común (81 % de los casos), pero pueden verse otros cambios como inversión profunda de ondas T o prolongación del QT en las primeras 48 horas (4,22).…”

“…Las principales complicaciones son observadas en la primera fase de la enfermedad, que incluye: la insuficiencia cardiaca aguda, arritmias ventriculares, ruptura de la pared libre del ventrículo izquierdo y trombos intracavitarios. No hay evidencia relevante y actualizada para definir un manejo óptimo de la enfermedad, pero es claro que se debe evitar el uso de simpaticomiméticos, además de recomendarse el tratamiento con betabloqueadores cardioselectivos y uso de inhibidores de la enzima convertidora de angiotensina (IECAs) en los pacientes con disfunción ventricular persistente; si existe choque cardiogénico, se aconseja el uso de inotrópicos y dispositivos de asistencia ventricular (21,22).…”