Echocardiographic Correlates of Acute Heart Failure, Cardiogenic Shock, and In-Hospital Mortality in Tako-Tsubo Cardiomyopathy

• Published in: JACC. Cardiovascular imaging Vol. 7; no. 2; pp. 119 - 129
• Main Authors: Citro, Rodolfo, MD, Rigo, Fausto, MD, D'Andrea, Antonello, MD, Ciampi, Quirino, MD, Parodi, Guido, MD, Provenza, Gennaro, MD, Piccolo, Raffaele, MD, Mirra, Marco, MD, Zito, Concetta, MD, Giudice, Roberta, MD, Patella, Marco Mariano, MD, Antonini-Canterin, Francesco, MD, Bossone, Eduardo, MD, Piscione, Federico, MD, Salerno-Uriarte, Jorge, MD
• Format: Journal Article
• Language: English
• Published: United States 01.02.2014
• Subjects: Acute Disease; Aged; Cardiovascular; Chi-Square Distribution; Female; Heart Failure - diagnostic imaging; Heart Failure - mortality; Heart Failure - physiopathology; Hemodynamics; Hospital Mortality; Humans; Italy - epidemiology; Logistic Models; Male; Middle Aged; Mitral Valve Insufficiency - diagnostic imaging; Mitral Valve Insufficiency - mortality; Multivariate Analysis; Predictive Value of Tests; Prognosis; Proportional Hazards Models; Risk Factors; Shock, Cardiogenic - diagnostic imaging; Shock, Cardiogenic - mortality; Shock, Cardiogenic - physiopathology; Stroke Volume; Takotsubo Cardiomyopathy - diagnostic imaging; Takotsubo Cardiomyopathy - mortality; Takotsubo Cardiomyopathy - physiopathology; Time Factors; Ultrasonography; Ventricular Function, Left; TTC; ejection fraction; RV; WMSI; BNP; echocardiography; brain natriuretic peptide; cardiogenic shock; LV; left ventricular outflow tract obstruction; tako-tsubo cardiomyopathy; LVOTO; sPAP; acute heart failure; left ventricular; EF; pulmonary artery systolic pressure; stress cardiomyopathy; right ventricular; MR; mitral regurgitation; CMR; left atrial; TAPSE; wall motion score index; tricuspid annular plane systolic excursion; LA; cardiac magnetic resonance
• ISSN: 1936-878X; 1876-7591
• DOI: 10.1016/j.jcmg.2013.09.020

Objectives The purpose of this study was to determine clinical and echocardiographic correlates of acute heart failure, cardiogenic shock and in-hospital mortality in a large cohort of tako-tsubo cardiomyopathy (TTC) patients. Background Despite good long-term prognosis, life-threatening complications due to hemodynamic instability can occur early in TTC patients. Methods The study population consisted of 227 patients (66.2 ± 12.2 years of age; females, 90.3%) enrolled in the Tako-tsubo Italian Network, undergoing transthoracic two-dimensional echocardiography on admission and at short-term follow-up (4.3 [4 to 6] weeks). Patients were divided into two groups according to the presence or absence of major adverse events, a composite of acute heart failure, cardiogenic shock, and in-hospital mortality. Results Major adverse events occurred in 59 patients (25.9%). The variables for elderly patients ≥75 years of age (42.4% vs. 23.8%; p = 0.011): left ventricular (LV) ejection fraction (35.1 ± 5.9% vs. 38.4 ± 4.6%, p < 0.001), wall motion score index (1.9 ± 0.2 vs. 1.7 ± 0.2, p < 0.001), E/e′ ratio (13.5 ± 4.3 vs. 9.9 ± 3.3 [where E/e′ is ratio of mitral E peak velocity and averaged e′ velocity], p < 0.001), LV outflow tract obstruction (23.7 vs. 8.9%, p = 0.006), pulmonary artery systolic pressure (47.4 ± 12.3 mm Hg vs. 38.0 ± 9.2 mm Hg; p < 0.001), right ventricular involvement (28.8 vs. 9.5%; p < 0.001), and reversible moderate-to-severe mitral regurgitation (49.1 vs. 11.9%; p < 0.001), were significantly different between groups and were associated with adverse events. At multivariate analysis, LV ejection fraction (HR: 0.92; 95% CI: 0.89 to 0.95; p < 0.001), E/e′ ratio (HR: 1.13; 95% CI: 1.02 to 1.24; p = 0.011), reversible moderate to severe mitral regurgitation (HR: 3.25; 95% CI: 1.16 to 9.10; p = 0.025), and age ≥75 years (HR: 2.81; 95% CI: 1.05 to 7.52; p = 0.039) were independent correlates of major adverse events. Conclusions Echocardiographic parameters provide additional information compared to other variables routinely used in clinical practice to identify patients at higher risk of hemodynamic deterioration and poor in-hospital outcome, allowing prompt institution of appropriate pharmacological treatment and adequate mechanical support.