Incidence and clinical/laboratory correlates of early hypotension in takotsubo syndrome

Abstract

Aims Takotsubo syndrome (TTS) is a form of acute myocardial inflammation, often triggered by catecholamine release surges, which accounts for approximately 10% of 'myocardial infarctions' in female patients above the age of 50. Its associated substantial risk of in-hospital mortality is mainly driven by the development of hypotension and shock. While hypotension is induced largely by factors other than low cardiac output, its precise cause is unknown, and clinical parameters associated with hypotension have not been identified previously. We therefore sought to identify the incidence and clinical/laboratory correlates of early hypotension in TTS. Methods and results We analysed the in-hospital data of patients recruited to the South Australian TTS Registry. Associations between the development of hypotension, patient demographics, severity of the acute TTS attack, and key biochemical markers were sought. One hundred thirteen out of 319 patients (35%) were hypotensive (median systolic blood pressure 80 mmHg) during their index hospitalization. Development of hypotension preceded all in-hospital deaths (n = 8). On univariate analyses, patients who developed hypotension had lower left ventricular ejection fraction (P = 0.009), and higher plasma N-terminal pro brain natriuretic peptide and troponin-T concentrations (P = 0.046 and 0.008, respectively), all markers of severity of the TTS attack; hypotension also occurred less commonly in male than in female patients (P = 0.014). On multivariate linear regression analysis, female sex and lower left ventricular ejection fraction were independent correlates of the development of hypotension (P = 0.009 and 0.010, respectively). Conclusions Early development of hypotension is very common in TTS, and its presence is associated with a substantial risk of in-hospital mortality. Hypotension is a marker of severe TTS attacks and occurs more commonly in female TTS patients.

Broken Heart Syndrome; A Recurrent Presentation in a Teenager Female

“…Our case fulfilled InterTAK diagnostic criteria of TTS Table (1). In contrast to our patient, TTS affects mainly postmenopausal women.…”

“…Takotsubo syndrome TTS is a cause of heart failure characterized by its transit course [1] . It has a wide range of clinical outcomes from mild to severe including heart failure, arrhythmias, thromboembolic consequences.…”

“…In its extreme forms it can cause cardiogenic shock, strokes and SCD. It is currently well established that patients who have TTS are at risk of recurrence with a rate of 2-3% per year and up to 20% in one study [1,2] . Those patient at risk of TTS recurrence are usually females with low body mass index (BMI).…”

Pivotal role of early coronary microvascular dysfunction in Takotsubo Syndrome

“…We have previously shown that occurrence of severe hypotension is independent of acute changes in pulmonary artery oxygen saturation (a marker of cardiac output) (7) and is statistically related to fall in LVEF, but only weakly so (6). The current analysis showed that minimal systolic blood pressure is significantly lower in patients without past histories of hypertension, and also in patients with greater increases in plasma troponin-T concentrations.…”

“…The major clinical problem encountered during the acute phase of TTS is symptomatic hypotension/shock, which is a marker of increased short-term mortality (5), even though it is not closely related to extent of simultaneous LV systolic dysfunction (6), nor to impairment of cardiac output (7).…”