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Short- and Long-Term Prognostic Relevance of Cardiogenic Shock in Takotsubo Syndrome

2018; Elsevier BV; Volume: 6; Issue: 11 Linguagem: Inglês

10.1016/j.jchf.2018.05.015

2213-1787

Manuel Almendro‐Delia, Iván J. Núñez‐Gil, Manuel Lobo, Mireia Andrés, Óscar Vedia, Alessandro Sionís, Ana Martín‐Garcia, Maria Aguilera, Eduardo Pereyra, Irene Martín de Miguel, José Antonio Linares Vicente, Miguel Corbí‐Pascual, Xavier Bosch, Óscar Fabregat Andrés, Alejandro Sánchez Grande Flecha, Alberto Pérez‐Castellanos, Javier López País, Manuel de Mora Martín, Juan Manuel Escudier-Villa, Roberto Martín‐Asenjo, Marta Guillén Marzo, Ferran Rueda, Álvaro Aceña, José María García‐Acuña, Juan C. Garcı́a-Rubira, Jaime Figueras, José A. Barrabés, Mireia Andrés, Iván J. Núñez‐Gil, H.D. Mejía, O Vedia, Gisela Feltes, Fernando Worner, Ramón Bascompte Claret, E Pereyra, Javier Jiménez‐Candil, M.J. García Sánchez, A.C. Martín García, Ana Martín‐Garcia, Vicente Bodı́, C. Bonanad, Teresa Bastante, Maria Aguilera, Jorge Palazuelos, D. Carmona, J Lopez Pais, Joaquín Alonso, M Almendro Delia, Martín Lobo, Sergio Rodríguez de Leiras, Juan C. Garcı́a-Rubira, Miguel Corbí‐Pascual, Juan Gabriel Córdoba Soriano, Manuel de Mora Martín, Beatriz Pérez, R. Martín Asensio, F Rueda Sobella, I. Santos Pardo, M C Nieto, Juan Manuel Escudier-Villa, Óscar Fabregat Andrés, Francisco Ridocci-Soriano, M.N. Parias Ángel, Hans Paul Gaebelt, Álvaro Aceña, R. Martin Reyes, C. Bergua, P. Sanz Puértolas, Ignacio Lucotti, Rafael Vidal-Pérez, Alessandro Sionís, Albert Duran‐Cambra, J. Tómas Ortiz, Xavier Bosch, Marta Guillén Marzo, R.A. Bardají, José María García‐Acuña, Alejandro Sánchez Grande Flecha, M. J. García González, G. Redondo, Alberto Pérez Castellanos, Jesús Piqueras‐Flores, Loles Herrero, José Antonio Linares Vicente, José R. Ruiz Arroyo, Juan Luis Garcı́a, José Antonio Giner, Manuel Martínez‐Sellés, Irene Martín de Miguel,

Cardiac Structural Anomalies and Repair

This study sought to describe the incidence, determinants, and prognostic impact of cardiogenic shock (CS) in takotsubo syndrome (TTS).TTS can be associated with severe hemodynamic instability. The prognostic implication of CS has not been well characterized in large studies of TTS.We analyzed patients with a definitive TTS diagnosis (modified Mayo criteria) who were recruited for the National RETAKO (Registry on Takotsubo Syndrome) trial from 2003 to 2016. Cox and competing risk regression models were used to identify factors associated with mortality and recurrences.A total of 711 patients were included, 81 (11.4%) of whom developed CS. Male sex, QTc interval prolongation, lower left ventricular ejection fraction at admission, physical triggers, and presence of "a significant" left intraventricular pressure gradient, were associated with CS (C index = 0.85). In-hospital complication rates, including mortality, were significantly higher in patients with CS. Over a median follow-up of 284 days (interquartile range: 94 to 929 days), CS was the strongest independent predictor of long-term, all-cause mortality (hazard ratio [HR]: 5.38; 95% confidence interval [CI]: 2.60 to 8.38); cardiovascular (CV) death (sub-HR: 4.29; 95% CI: 2.40 to 21.2), and non-CV death (sub-HR: 3.34; 95% CI: 1.70 to 6.53), whereas no significant difference in the recurrence rate was observed between groups (sub-HR: 0.76; 95% CI: 0.10 to 5.95). Among patients with CS, those who received beta-blockers at hospital discharge experienced lower 1-year mortality compared with those who did not receive a beta-blocker (HR: 0.52; 95% CI: 0.44 to 0.79; pinteraction = 0.043).CS is not uncommon and is associated with worse short- and long-term prognosis in TTS. CS complicating TTS may constitute a marker of underlying disease severity and could identify a masked heart failure phenotype with increased vulnerability to catecholamine-mediated myocardial stunning.