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Abstract
Takotsubo syndrome following cardiac surgery is a rare occurrence. However, early diagnosis is essential to prevent treatment which could increase the left ventricular outflow tract pressure gradient in patients with Takotsubo syndrome, and lead to cardiogenic shock. Therefore, our study aimed to identify the incidence of Takotsubo syndrome after cardiopulmonary bypass and the associated risk factors and prognosis. We retrospectively studied 5773 patients who underwent cardiopulmonary bypass between February 2007 and July 2017. Among these, Takotsubo syndrome was diagnosed in 52 (0.9%). To evaluate the risk factors for Takotsubo syndrome, 104 of the remaining 5721 patient were randomly selected as the control group (1:2 ratio). Univariate and multivariate logistic regression analyses were used for risk factor analysis. Majority of patients (69.2%) in the Takotsubo syndrome group underwent mitral valve surgery, compared with 32.7% in the control group. The following risk factors of Takotsubo syndrome were identified: atrio-ventricular valve surgery (odds ratio (OR) 10.5; 95% confidence interval (CI), 2.6-42.5; p = 0.001); and the immediate postoperative use of epinephrine (OR, 3.3; 95% CI, 1.0-10.7; p = 0.05) and dobutamine (OR, 4.8; 95% CI, 1.72-13.3; p = 0.003). Hypertension was a significant protective factor against Takotsubo syndrome following cardiac surgery (OR, 0.22; 95% CI, 0.06-0.73; p = 0.01). Takotsubo syndrome following cardiac surgery is rare. Immediate postoperative use of epinephrine and doputamine, as well as atrio-ventricular valve surgery were factors associated with the development of Takotsubo syndrome.
Highlights
Takotsubo syndrome following cardiac surgery is a rare occurrence
Immediate postoperative use of epinephrine and doputamine, as well as atrio-ventricular valve surgery were factors associated with the development of Takotsubo syndrome
The following variables were retained as independent risk factors for Takotsubo syndrome: Atrioventricular valve surgery (OR, 10.5; 95%confidence interval (CI), 2.6–42.5; P = 0.001), and the immediate postoperative use of epinephrine (OR, 3.3; 95%CI, 1.0-10.7; P = 0.05) and dobutamine (OR, 4.8; 95%CI, 1.72–13.3; P = 0.003)
Summary
Takotsubo syndrome following cardiac surgery is a rare occurrence. Early diagnosis is essential to prevent treatment which could increase the left ventricular outflow tract pressure gradient in patients with Takotsubo syndrome, and lead to cardiogenic shock. In 2007, Itoh et al [7] reported on Takotsubo syndrome following cardiac surgery (mitral valve repair), leading the authors to suggest that myocardial stunning, caused by cardiopulmonary bypass, might be a cause of Takotsubo syndrome [7]. Takotsubo syndrome preceded by cardiac surgery, is a very rare occurrence with only a few cases having been reported in the literature. Despite the low prevalence of Takotsubo syndrome after cardiac surgery, accurate diagnosis of the syndrome, and its differential diagnosis from low cardiac output syndrome following cardiac surgery, is essential as the use of catecholamines and beta-receptor agonists may increase the left ventricular outflow tract (LVOT)
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