Abstract
BackgroundRecent hypotheses have suggested the pathophysiological role of catecholamines in the evolution of the Takotsubo syndrome (TTS). The extent of cardiac and circulatory compromise dictates the use of some form of supportive therapy. This study was designed to investigate the clinical outcomes associated with catecholamine use in TTS patients.MethodsOur institutional database constituted a collective of 114 patients diagnosed with TTS between 2003 and 2015. The study-patients were subsequently classified into two groups based on the need for catecholamine support during hospital stay (catecholamine group n = 93; 81%, non-catecholamine group = 21; 19%). The primary end-point of our study was all-cause mortality.ResultsPatients receiving catecholamine support showed higher grades of circulatory and cardiac compromise (left ventricular ejection fraction (LVEF) 39.6% vs. 32.7%, p-value < 0.01) and the course of disease was often complicated by the occurrence of different TTS-associated complications. The in-hospital mortality (3.2% vs. 28.5%, p < 0.01), 30-day mortality (17.2% vs. 51.4%, p < 0.01) as well as long-term mortality (38.7% vs. 80.9%, p < 0.01) was significantly higher in the group of patients receiving catecholamine support. A multivariate Cox regression analysis attributed EF ≤ 35% (HR 3.6, 95% CI 1.6–8.1; p < 0.01) and use of positive inotropic agents (HR 2.2, 95% CI 1.0–4.8; p 0.04) as independent predictors of the adverse outcome.ConclusionRates of in-hospital events and short- as well as long-term mortality were significantly higher in TTS patients receiving catecholamine support as compared to the other study-patients. These results need further evaluation in pre-clinical and clinical trials to determine if external catecholamines contribute to an adverse clinical outcome already compromised by the initial insult.
Highlights
Recent hypotheses have suggested the pathophysiological role of catecholamines in the evolution of the Takotsubo syndrome (TTS)
The clinical parameters used to ascertain patient status, such as systolic blood pressure (134.96 ± 28.41 mmHg vs. 116.25 ± 42.3 mmHg, p = 0.01) and heart rate (98.1 ± 27.6 bpm vs. 110.9 ± 22.7 bpm, p = 0.03), expectedly showed variation between the two groups, wherein lower blood pressure values and mild tachycardia was frequently observed among patients requiring catecholamine support
Right ventricular involvement was less pronounced in the non-catecholamine support patient-group (18.2%, n = 17 vs. 42.85%, n = 9, p = 0.02)
Summary
Recent hypotheses have suggested the pathophysiological role of catecholamines in the evolution of the Takotsubo syndrome (TTS). This study was designed to investigate the clinical outcomes associated with catecholamine use in TTS patients. The Takotsubo Syndrome (TTS) is as an acute and usually reversible from of heart failure characterized by a transient dysfunction of the left ventricle [1, 2]. Stressful triggers could potentially contribute to an increased hypothalamic-pituitaryadrenal axis (HPA) gain and catecholamine release. This resulting catecholamine surge possibly directs a pathological response from the cardiovascular as well the sympathetic nervous system and serves as the basis for the evolution of TTS [15, 16]
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