Protective effect of acquired long QT syndrome in Takotsubo syndrome

Abstract

Background Clinical variables that predict long‐term mortality and recurrence of Takotsubo syndrome (TTS) are not completely understood as the role of acquired corrected QT interval (QTc) prolongation. Aim To detect the prevalence of QTc interval prolongation in patients with TTS and to evaluate its long‐term prognostic impact. Methods QTc intervals were analysed in 105 patients presenting with symptoms of TTS. These patients were included in an ongoing retrospective cohort database. The cohort was subsequently subdivided into two groups based on the presence (long QT (LQT) group, n = 73, 69.52%) or absence (non‐long QT (non‐LQT) group, n = 32, 30.43%) of QTc interval prolongation. Patients were followed up over a mean period of 4.2 years. The rate of life‐threatening arrhythmia during the first 30 days in the LQT group was comparable with the non‐LQT group (10.9 vs 12.5%), whereas in‐hospital mortality and 30‐day mortality occurred less frequently in the LQT group (2.7 vs 18.75%, P < 0.01). Results During this time span, 17 (23.3%) patients with acquired LQT syndrome died, whereas 14 (43.7%) patients with non‐LQT duration died. Kaplan–Meier survival rates were significantly higher in the LQT group than those in the non‐LQT group (Log‐rank‐test, P = 0.02). On multivariate analysis, the QTc interval was an independent negative predictor of all‐cause mortality (P = 0.02). Conclusion The QTc interval at admission is an independent negative predictor of long‐term adverse outcome in patients with TTS.

Prognostic factors of Takotsubo cardiomyopathy: a systematic review

“…22 Other studies found no association between sex and the long-term outcomes of TCM. [52][53][54][55][56][57][58][59][60] One study by Uribarri et al found that male sex was not associated with 5 year mortality in TCM patients (P = 0.076). 55 Another study that included 1604 TCM patients found that sex was not associated with 10 year mortality (P = 0.17).…”

“… 22 Other studies found no association between sex and the long‐term outcomes of TCM. 52 , 53 , 54 , 55 , 56 , 57 , 58 , 59 , 60 One study by Uribarri et al . found that male sex was not associated with 5 year mortality in TCM patients ( P = 0.076).…”

The Ominous Triad of Severe Takotsubo Cardiomyopathy

“…In earlier studies, polymorphic VT is considered uncommon and occurs only in 1-1.5% of cases with acquired long QT due to TCM [ 9 ]. Hohneck et al retrospectively analyzed 105 patients with TCM and concluded that QT interval prolongation is a negative independent predictor of adverse outcome [ 16 ]. In a prospective cohort study, Imran et al have shown that TCM patients with a long QT interval, or developed acquired long QT syndrome, are more likely to be intubated, require vasopressor support, develop cardiogenic shock, ventricular arrhythmias, and death than those with a normal QT interval [ 7 ].…”

Revisitando o Intervalo QT: Um Antigo Marcador para uma Nova Doença?

“…However, from the multivariate analysis, the authors conclude that QTc interval prolongation on hospital admission is an independent negative predictor for unfavorable outcomes associated with this condition. 11 In an elegant study, Gibbs et al described the 30-day to 3-year mortality of 980 patients admitted to a general hospital with QTc≥500 ms compared to 980 patients with QTc interval<500 ms, due to different clinical causes and already adjusted for age, sex, Charlson index, previous admission, and main diagnosis. The authors conclude that the QTc≥500 ms is an important predictor of mortality in the short term and, in the long term, the comorbidities found are the main factor related to the overall mortality rate.…”

“…A ocorrência de arritmias malignas durante os 30 dias iniciais foi similar em ambos os grupos (10,9% vs. 12,5%), mas a partir da análise multivariada, os autores concluem que o prolongamento do intervalo QTc na admissão hospitalar é um preditor negativo independente para desfechos desfavoráveis associados a esta condição. 11 …”