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

Abstract

IntroductionTakotsubo cardiomyopathy (TTC), also called stress cardiomyopathy, is a transient reversible left ventricular dysfunction mimicking acute coronary syndrome (ACS). Studies have shown similar rates of in-hospital complications in TTC and myocardial infarction (MI). Left bundle branch block (LBBB) is associated with increased mortality in patients with MI; however, similar studies comparing outcomes of TTC in the presence of LBBB are lacking.MethodsThe 2016 National Inpatient Sample (NIS) database was queried to identify all admissions with a primary discharge diagnosis of TTC. Diagnosis-specific codes were used to stratify patients based on the presence or absence of LBBB. Both population sets were paired using 1:10 propensity score matching. Multivariate logistic regression analysis was performed to compare various in-hospital outcomes among both groups.ResultsAmongst 7270 admissions for TTC, 226 patients had concomitant LBBB. After performing 1:10 propensity matching, 130 patients with LBBB were compared to 1275 patients without LBBB. The presence of LBBB was associated with increased odds of cardiogenic shock (AOR = 2.2, 95% CI 1.21–3.99, p = 0.0097); ventricular arrhythmia (AOR 1.99, 95% CI 1.11–3.57, p = 0.02), acute congestive heart failure (AOR = 1.49, 95% CI 1.01–2.2, p = 0.04), and sudden cardiac arrest (AOR = 3.37, 95% CI 1.59–7.13, p = 0.0001). There was no statistical difference in all-cause in-hospital mortality, however a trend towards worsening was noted.ConclusionsThe incidence of arrhythmia and shock in patients with TTC does not correlate with the extent of myocardium involvement. The presence of LBBB in such cases can help recognize at-risk populations, and with timely intervention, life-threatening complications can be avoided. Despite limitations of the dataset and inability to establish causality, prospective studies with longer follow-up are warranted.

Impact of left bundle branch block in Takotsubo Syndrome

“…A previous study using the NIS found an association between TTS with LBBB and ventricular arrhythmias, SCA, cardiogenic shock, and acute HF, but not with all-cause in-hospital mortality during admission. [11] Our study aimed to expand upon these findings analyzing a significantly larger sample size and it did not find any association between LBBB and acute HF, acute kidney injury, cardiogenic shock, all-cause mortality, and hospital length of stay during the index admission in patients with TTS after multivariate adjustment. [9] .…”

“…A small descriptive study found that LBBB had no effect on all-cause mortality during admission but was independently associated with several complications in patients admitted with TTS. [11] .…”

Case report: takotsubo syndrome in infectious endocarditis

“…As patients with left bundle branch block were not eligible for inclusion, the score could not be applied in the presented case [6,8,9]. Moreover, the presence of a LBBB pattern in TTS patients has been associated with a higher incidence of arrhythmia and shock in TTS patients [10]. However, in our patient, the LBBB had already been known since after the first surgical aortic valve replacement and was not related to TTS.…”