Abstract 15511: Predictors of Polymorphic Ventricular Tachycardia and Ventricular Fibrillation in Patients With Stress Cardiomyopathy

Abstract

Introduction: Polymorphic ventricular tachycardia (PVT) and ventricular fibrillation (VF) are life-threatening complications of stress cardiomyopathy (SCM) that occur in 2-10% of patients with SCM. Hypothesis: To identify which social and medical factors are associated with an increased risk of PVT and VF in patients with SCM. Methods: All consecutive patients meeting the InterTAK (international takotsubo) diagnostic criteria for stress cardiomyopathy at the Hennepin County Medical Center between January 1 st , 2010, and December 31 st , 2022, were identified from electronic medical records. Logistic regression was used to estimate the odds ratios (OR). The receiver operating characteristic curve (ROC) was plotted to identify the best QTc cutoff at admission to predict ventricular arrhythmia. Results: A total of 296 patients were included in the study, of which 27 (9.1%) experienced PVT/VF. Baseline demographics, including gender, race, and age at diagnosis, were similar to patients without PVT/VF (median age 61 years, and 66.7% were females). Patients with PVT/VF were more likely to have a history of stimulant use (22.2% vs. 8.2%, OR =3.20 p =0.023), apical (Takotsubo) variant stress cardiomyopathy (78% vs.56%, OR=2.69 p=0.038), and an ejection fraction (EF) of less than 30% on admission (63% vs. 41.5%, OR=2.39 p=0.032) ( Table 1 ). Admission QTc interval cut-off value of 490 msec had the highest sensitivity and specificity in predicting the risk of ventricular arrhythmia (AUC=0.687). Notably, all PVT/VF events occurred within 17 hours of hospital admission. Conclusion: Nealy 1 in 10 patients with SCM had life-threatening ventricular arrhythmia. The presence of severe LV systolic dysfunction, recent stimulant use, apical variant SCM, or prolonged QTc > 490 msec is associated with the occurrence of PVT/VF, with the first day of hospital admission being an especially high-risk period.