Impact of T‐inversion on the outcome of Takotsubo syndrome as compared to acute coronary syndrome

Abstract

Background Previous studies revealed that patients with Takotsubo syndrome (TTS) have a higher mortality rate than the general population and a comparable mortality to acute coronary syndrome (ACS). Repolarisation abnormalities, namely T‐wave amplitude, may provide incremental prognostic information, in addition to traditional risk factors in ACS. This study was performed to determine the short‐ and long‐term prognostic impact of inverted T‐waves in TTS patients, as compared to ACS patients. Methods and results Our institutional database constituted a collective of 138 patients diagnosed with TTS from 2003 to 2017, as well as 532 patients suffering from ACS. Patients with TTS or with ACS (n = 138 per group) were matched for age and sex and assessed retrospectively and prospectively and divided into two groups, TTS with inverted T‐waves (n = 123) and ACS with inverted T‐waves (n = 80). In‐hospital complications such as respiratory failure with the need of respiratory support (60.2% vs 6.3%; P < 0.01), thromboembolic events (13.8% vs 2.5%; P < 0.01) and cardiogenic shock (18.9% vs 8.8%; P = 0.05) were significantly more presented in TTS as compared to ACS patients. Among cardiovascular risk factors diabetes mellitus (23.6% vs 45.0%; P < 0.01) and arterial hypertension (57.7% vs 78.8%; P < 0.01) were more presented in ACS patients as compared to TTS patients. Short‐term mortality was similar, however the long‐term mortality of 5 years was significantly higher in the TTS group (25.2% vs 7.5%; P < 0.01). In univariate analysis were male gender, EF < 35%, GFR < 60 mL/min, cardiogenic shock, inotropic drugs and history of cancer predictors of 5‐year mortality. The multivariate analysis showed only male gender (HR 2.7, 95% CI 1.1‐6.5; P = 0.02), GFR < 60 mL/min (HR 2.8, 95% CI 1.2‐6.0; P = 0.01) and history of cancer (HR 3.6, 95% CI 1.4‐9.3; P < 0.01) as independent predictors of 5‐year mortality. Conclusion Rates of long‐term mortality were significantly higher in TTS patients showing inverted T‐waves compared with patients diagnosed with ACS with inverted T‐waves. However, T‐inversion was not an independent predictor of 5‐year mortality in the multivariate analysis.

Prognostic factors of Takotsubo cardiomyopathy: a systematic review

“…Some studies indicate that being male is associated with poorer outcomes. 21,22,[40][41][42][43][44][45][46][47][48][49][50][51] Ghadri et al found that the risk of all-cause mortality of male patients was 1.75 times higher than that of female patients in a 5 year follow-up study [hazard ratio (HR) 1.75, 95% CI 1.13-2.70] in a prospective study with a large sample (1450 female and 163 male). 42 Another retrospective study, which included 19 966 TCM patients, by Murugiah et al noted that among patients with primary TCM, male patients had a higher 1 year mortality rate (12.0% vs. 6.6%, P < 0.05).…”

“…Some studies indicate that being male is associated with poorer outcomes. 21 , 22 , 40 , 41 , 42 , 43 , 44 , 45 , 46 , 47 , 48 , 49 , 50 , 51 Ghadri et al . found that the risk of all‐cause mortality of male patients was 1.75 times higher than that of female patients in a 5 year follow‐up study [hazard ratio (HR) 1.75, 95% CI 1.13–2.70] in a prospective study with a large sample (1450 female and 163 male).…”

“…Some studies with small cohorts have shown that CKD is a predictor of poor long‐term outcomes in TCM patients. 21 , 43 , 45 , 50 , 51 , 54 , 58 , 99 , 100 , 101 A study of 95 patients compared mortality between patients with an eGFR higher than 60 mL/[min 1.73 m 2 ] (65 patients) with those who had eGFR < 60 mL/[min 1.73 m 2 ] (30 patients). Patients in the lower eGFR group had a higher 3 year mortality rate (33.3% vs. 15.4%, P = 0.047) than patients in the higher eGFR group.…”

“…Malignant disease remains a predictor of poorer long‐term outcome in TCM patients. 26 , 41 , 42 , 43 , 44 , 45 , 51 , 54 , 56 , 60 , 62 , 71 , 75 , 77 , 86 , 107 , 108 , 109 The latest meta‐analysis of the association between malignant disease and TCM patients included 10 studies and 126 322 patients and suggested that malignant disease was associated with greater mortality in TCM patients (RR 2.23, 95% CI 1.64–3.03,), including both inpatient mortality (RR 2.26, 95% CI 1.34–3.82) and long‐term mortality (RR 2.04, 95% CI 1.63–2.55). 107 In one study of 1604 TCM patients, those with malignant disease had a higher 10 year mortality rate (HR 1.84, 95% CI 1.29–2.61).…”

Implications of Left Bundle Branch Block in Takotsubo Cardiomyopathy: Propensity Match Analysis from the National Inpatient Sample

“…Active malignancy or even a history of cancer increases mortality in TTC [37]. The mortality rates were higher in TTC patients presenting with T-wave inversion on EKG compared to ACS patients with a similar electrocardiographic presentation [38]. Similar results were not seen in those presenting with ST-elevation on EKG [39].…”