008 Non invasive coronary flow reserve is a powerful independent predictor of in-hospital complications in Tako-Tsubo syndrome

Abstract

Several in-hospital complications (HC) could impair the clinical course of tako-tsubo syndrome (TTS). to assess the clinical and echocardiographic predictors of HC in TTS. 37 consecutive patients (pts) (mean age, 69 ± 10 years, 35 women) with a typical TTS according to the Mayo Clinic criteria underwent prospectively a comprehensive transthoracic Doppler-echocardiography including the non invasive assessment of coronary flow reserve (CFR), measured in the distal part of the left anterior descending artery using intravenous adenosine infusion, at the acute phase (within 24–48 h of symptom onset) and after recovery (1 month apart). Clinical and biochemical parameters were also assessed. HC were defined as cardiogenic shock, or thrombo-embolic event. HC occurred in 8 cases (22%). Pts with HC, compared to pts without HC, were more frequently diabetics (63% vs. 21%, p < 0.05), and had at the acute phase a more severely impaired CFR (1.8 ± 0.5 vs. 2.3 ± 0.4, p<0.01), left ventricular (LV) ejection fraction (33 ± 8% vs. 41 ± 9%,), wall motion score index, and LV systolic volume/m 2 (all, p < 0.05), Age, frequency of ECG ST-segment elevation at presentation, troponin peak, and preexisting beta-blockers use, were not significantly different in pts with and without HC (all, p = NS). The in-hospital length of stay was longer in the former group (p < 0.05). After recovery, CFR improved significantly in both groups. However, the magnitude of improvement was higher in pts with HC as compared to pts without HC (74% vs. 27%, p < 0.05) leading to final value of CFR similar in both groups (2.9 ± 0.4 vs. 3.1 ± 0.6, p = NS). In multivariate analysis, the only independent predictor of HC was acute CFR (p = 0.028). Using a ROC curve analysis a CFR < 1.9 was the best cut-off to predict HC with a sensitivity of 75% and specificity of 86%, (AUC 0.76, p < 0.01). With a mean follow-up of 24 ± 10 months, one patient died in the group of HC vs. none in the other group. CFR is an independent predictor of HC, suggesting that the impairment of the coronary microcirculation is important at the acute phase of TTS.