Clinical predictors of late left ventricle recovery in tako-tsubo syndrome

Abstract

Abstract Funding Acknowledgements None. Introduction Tako-Tsubo syndrome (TTS) or stress cardiomyopathy is characterized by transient dysfunction of the left ventricle (LV) and a clinical presentation that can mimic an acute coronary syndrome. Recovery from contraction abnormalities may occur hours to weeks after the acute event. Although traditionally considered a disease with a favorable prognosis, it has been observed to have a complication rate during hospitalization similar to acute myocardial infarction and a significant mortality rate during follow-up (greater than 5% per patient-year). The recovery time of LV function has demonstrated important prognostic value. Purpose The aim of this work was to determine the clinical predictors of late left ventricular recovery in TTS. Methods Data from the multicenter national registry on Takotsubo Syndrome (RETAKO) were utilized. Clinical, laboratory, echocardiographic, and other imaging test characteristics, as well as events during hospitalization and follow-up, were collected. Recovery within the first days after the acute event was considered early recovery. Patients who died within the first 10 days after the acute event were excluded. Results A total of 1,463 patients were analyzed, of whom 373 (25.5%) had late recovery. The mean age was 71 years, and 86.6% were women. In the late recovery group, factors more common were age over 75 years, male gender, neurological disease, lung disease, peripheral arterial disease, active cancer, physical trigger, initial presentation as dyspnea or syncope, presence of shock, greater left ventricular dysfunction at diagnosis, and higher levels of proBNP. In multivariate analysis, the presence of neurological disease, active cancer, shock during hospitalization, lower initial LV ejection fraction, and physical trigger were associated with late recovery. Conclusions Patients with TTS showing late recovery of LV function have different clinical characteristics and disease presentation compared to those with early recovery. Late recovery was associated with the presence of neurological disease or active cancer, shock during hospitalization, lower initial LV ejection fraction, and physical trigger.