Clinical Predictors and Prognostic Impact of Recovery of Wall Motion Abnormalities in Takotsubo Syndrome: Results From the International Takotsubo Registry

Stjepan Jurisic, Sebastiano Gili, Victoria L Cammann, Ken Kato, Konrad A Szawan, Fabrizio D'Ascenzo, Milosz Jaguszewski, Eduardo Bossone, Rodolfo Citro, Annahita Sarcon, L Christian Napp, Jennifer Franke, Michel Noutsias, Maike Knorr, Susanne Heiner, Christof Burgdorf, Wolfgang Koenig, Alexander Pott, Behrouz Kherad, Lawrence Rajan, Guido Michels, Roman Pfister, Alessandro Cuneo, Claudius Jacobshagen, Mahir Karakas, Philippe Meyer, Jose David Arroja, Adrian Banning, Florim Cuculi, Richard Kobza, Thomas A Fischer, Tuija Vasankari, K E Juhani Airaksinen, Rafal Dworakowski, Christoph Kaiser, Stefan Osswald, Leonarda Galiuto, Wolfgang Dichtl, Christina Chan, Paul Bridgman, Daniel Beug, Clément Delmas, Olivier Lairez, Martin Kozel, Petr Tousek, David E Winchester, Ekaterina Gilyarova, Alexandra Shilova, Mikhail Gilyarov, Ibrahim El-Battrawy, Ibrahim Akin, Jan Galuszka, Christian Ukena, Gregor Poglajen, Carla Paolini, Claudio Bilato, Pedro Carrilho-Ferreira, Fausto J Pinto, Grzegorz Opolski, Philip MacCarthy, Yoshio Kobayashi, Abhiram Prasad, Charanjit S Rihal, Petr Widimský, John D Horowitz, Carlo Di Mario, Filippo Crea, Carsten Tschöpe, Burkert M Pieske, Gerd Hasenfuß, Wolfgang Rottbauer, Ruediger C Braun-Dullaeus, Stephan B Felix, Martin Borggrefe, Holger Thiele, Johann Bauersachs, Hugo A Katus, Heribert Schunkert, Thomas Münzel, Michael Böhm, Jeroen J Bax, Thomas F Lüscher, Frank Ruschitzka, Jelena R Ghadri, Christian Templin, Stjepan Jurisic, Sebastiano Gili, Victoria L Cammann, Ken Kato, Konrad A Szawan, Fabrizio D'Ascenzo, Milosz Jaguszewski, Eduardo Bossone, Rodolfo Citro, Annahita Sarcon, L Christian Napp, Jennifer Franke, Michel Noutsias, Maike Knorr, Susanne Heiner, Christof Burgdorf, Wolfgang Koenig, Alexander Pott, Behrouz Kherad, Lawrence Rajan, Guido Michels, Roman Pfister, Alessandro Cuneo, Claudius Jacobshagen, Mahir Karakas, Philippe Meyer, Jose David Arroja, Adrian Banning, Florim Cuculi, Richard Kobza, Thomas A Fischer, Tuija Vasankari, K E Juhani Airaksinen, Rafal Dworakowski, Christoph Kaiser, Stefan Osswald, Leonarda Galiuto, Wolfgang Dichtl, Christina Chan, Paul Bridgman, Daniel Beug, Clément Delmas, Olivier Lairez, Martin Kozel, Petr Tousek, David E Winchester, Ekaterina Gilyarova, Alexandra Shilova, Mikhail Gilyarov, Ibrahim El-Battrawy, Ibrahim Akin, Jan Galuszka, Christian Ukena, Gregor Poglajen, Carla Paolini, Claudio Bilato, Pedro Carrilho-Ferreira, Fausto J Pinto, Grzegorz Opolski, Philip MacCarthy, Yoshio Kobayashi, Abhiram Prasad, Charanjit S Rihal, Petr Widimský, John D Horowitz, Carlo Di Mario, Filippo Crea, Carsten Tschöpe, Burkert M Pieske, Gerd Hasenfuß, Wolfgang Rottbauer, Ruediger C Braun-Dullaeus, Stephan B Felix, Martin Borggrefe, Holger Thiele, Johann Bauersachs, Hugo A Katus, Heribert Schunkert, Thomas Münzel, Michael Böhm, Jeroen J Bax, Thomas F Lüscher, Frank Ruschitzka, Jelena R Ghadri, Christian Templin

Abstract

Background Left ventricular (LV) recovery in takotsubo syndrome (TTS) occurs over a wide-ranging interval, varying from hours to weeks. We sought to investigate the clinical predictors and prognostic impact of recovery time for TTS patients. Methods and Results TTS patients from the International Takotsubo Registry were included in this study. Cut-off for early LV recovery was determined to be 10 days after the acute event. Multivariable logistic regression was used to assess factors associated with the absence of early recovery. In-hospital outcomes and 1-year mortality were compared for patients with versus without early recovery. We analyzed 406 patients with comprehensive and serial imaging data regarding time to recovery. Of these, 191 (47.0%) had early LV recovery and 215 (53.0%) demonstrated late LV improvement. Patients without early recovery were more often male (12.6% versus 5.2%; P=0.011) and presented more frequently with typical TTS (76.3% versus 67.0%, P=0.040). Cardiac and inflammatory markers were higher in patients without early recovery than in those with early recovery. Patients without early recovery showed unfavorable 1-year outcome compared with patients with early recovery (P=0.003). On multiple logistic regression, male sex, LV ejection fraction <45%, and acute neurologic disorders were associated with the absence of early recovery. Conclusions TTS patients without early LV recovery have different clinical characteristics and less favorable 1-year outcome compared with patients with early recovery. The factors associated with the absence of early recovery included male sex, reduced LV ejection fraction, and acute neurologic events. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01947621.

Keywords: outcome; recovery; takotsubo syndrome; wall motion abnormalities.

Figures

Figure 1
Figure 1
Study flowchart. +WMA indicates persistent wall motion abnormalities; −WMA, complete resolution of wall motion abnormalities.
Figure 2
Figure 2
Long‐term outcome in takotsubo syndrome (TTS) patients with and without early recovery. Kaplan–Meier survival analysis demonstrated significant differences in 1‐year mortality in TTS patients without early recovery than in those with early recovery (P=0.003).
Figure 3
Figure 3
Factors associated with absence of early recovery. Multivariable logistic regression, adjusted for potential confounders, demonstrated that male sex, left ventricular ejection fraction

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