A sneak peek on Takotsubo Syndrome

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. INTRODUCTION Takotsubo syndrome (TS) is characterized by transient wall motion abnormality of the left ventricle, which may happen in response to different triggers. AIM To characterize the population with confirmed diagnosis of TS. METHODS We analysed retrospectively 129 patients (pts) admitted in our center from 2010 to 2018 with this presumptive diagnosis. 29pts were excluded because TS wasn´t confirmed. For each pt we evaluate clinical characteristics, exams results, inhospital complications and long-term outcomes (minimum FUP of 1 year). RESULTS The average age was 66 years and 89% were females. Regarding the cardiovascular (Cv) risk factors, 78% had hypertension, 53% dyslipidemia and 19% Diabetes mellitus. In relation to noncardiovascular comorbidities it’s important to point out that 32% had psychiatric disorders. The trigger was emotional in 37%, physical in 18%, and unidentifiable in 45%. Concerning the clinical presentation 72% had Killip(K) 1 and 13% K≥3 at admission. The initial electrocardiogram had ST-elevation in 37%, T wave inversion in 64% and a mean QTc interval of 470ms. The mean ejection fraction (EF) by echocardiogram was 37%, with apical ballooning in 83% and at least moderate mitral regurgitation (MR) in 11%. Only 16% had intraventricular pressure gradient. Coronarography revealed absence of obstructive coronary disease in 71% of pts. In addition, 51% of pts underwent cardiac magnetic resonance (CMR), which had an increase usage since 2013. The mean time until the CMR was 14 days, which may explain why only 14% had segmental kinetic changes. It’s noteworthy that the mean peak NTproBNP/troponin I ratio was 1,4 ± 2,9. We compared the ratio in TS with EF < 40% with the one obtained in a cohort of ST-elevation myocardial infarction (MI) with EF < 40% and found statistically difference (1,7 ± 3,8vs0,01 ± 0,03; p < 0,001). Considering inhospital complications, 6% had intracardiac thrombus, 2% acute severe MR, 2% ventricular dysrhythmia and 2% died. During the FUP, 2% had recurrence, 4% had acute heart failure hospitalizations an 17% died. CONCLUSION Despite increased awareness TS is still poorly recognized. Lack of non-invasive tools for reliable diagnosis obliged the use of coronarography. It’s noteworthy that the peak NTproBNP/troponin I ratio may help to differentiate TS from MI and the use of CMR should be encouraged to exclude other causes. Although considered a benign condition, significant in-hospital mobility and 2% mortality was observed.