Renal impairment and outcome in Takotsubo syndrome: Insights from a national multicentric cohort

INTRODUCTION

Data on the association between kidney function and Takotsubo syndrome (TTS) outcomes are scarce and conflictive.

OBJECTIVE

To assess the impact of chronic kidney disease (CKD) and acute renal failure (ARF) in patients with TTS.

MATERIAL AND METHODS

Patients from the prospective nation-wide (RETAKO) registry were included and divided into quartiles of maximum creatinine (Cr) level during hospitalization.

RESULTS

The prevalence of CKD and ARF in the whole RETAKO cohort was 5.4% and 11.7%, respectively. Compared to Q1 (Cr <0.71), patients within Q4 (Cr > 1.1) had lower left ventricular ejection fraction on admission (38.5 ± 12 vs 43.3 ± 11.3, p = 0.002) and higher bleeding rates during hospitalization (6.7% vs 2%, p = 0.005). In addition, compared to Q1, Q4 patients have a greater incidence of cardiogenic shock (17.3% vs 5.6%, p < 0.001), and a higher rate of 5-year all-cause death and major adverse cardiovascular events (31.5% vs 15.8%, p < 0.001 and 22.5% vs 9.3%, p < 0.001, respectively).

CONCLUSIONS

TTS patients with CKD have a higher incidence of ARF and exhibit greater Cr on admission, which were linked with higher rates of cardiogenic shock, bleeding during hospitalization as well as major adverse cardiovascular events and all-cause death during a 5-year follow-up.

Recovery of Left Ventricular Function and Long-Term Outcomes in Patients With Takotsubo Syndrome

BACKGROUND

Takotsubo syndrome (TTS) is a form of transient left ventricular (LV) dysfunction that usually resolves within days to weeks.

OBJECTIVES

We aimed to assess the predictors and prognostic impact of time-to-LV recovery after TTS.

METHODS

Prospective serial imaging data from the nationwide, multicenter RETAKO (REgistry on TAKOtsubo Syndrome) were comprehensively reviewed to assess the timing of LV recovery. Multivariable logistic regression was used to assess factors associated with late (≥10 days) vs early (<10 days) recovery. The long-term risk of all-cause mortality was compared between the late and early recovery groups using fully adjusted Cox models, and using flexible parametric survival models with recovery time included as a continuous variable.

RESULTS

Of 1,463 patients included (median age 73 years, 13% men), 373 (25%) had late and 1,090 (75%) had early LV recovery. Older age, history of neurological disorders, bystander coronary artery disease, active cancer, physical triggers, elevated inflammatory biomarkers, cardiogenic shock, and lower LV ejection fraction at admission were independent predictors of late recovery. At 4-year follow-up, the adjusted risk of death was significantly higher in patients with late recovery compared with those with early recovery (16.0% vs 8.6%, adjusted HR: 1.31; 95% CI: 1.12-1.60), with the risk of death increasing by 8% for every additional 10-day delay in time-to-LV recovery (adjusted HR: 1.08; 95% CI: 1.04-1.13).

CONCLUSIONS

Late recovery of LV function after TTS is associated with reduced short- and long-term survival. In TTS patients without early LV recovery, closer clinical follow-up might be considered.

Intraventricular thrombus in Takotsubo syndrome: Incidence, predictors, management, and prognosis. Insights from the RETAKO registry

BACKGROUND

Takotsubo syndrome (TTS) is characterized by transient left ventricular (LV) dysfunction and wall motion abnormalities without culprit coronary artery disease. LV thrombus (LVT) formation during the acute phase is a fearsome complication.

OBJECTIVES

To identify factors associated with LVT and its prognostic impact in TTS patients.

METHODS

Data from the nationwide REgistry on TAKOtsubo syndrome (RETAKO), which combines retrospective (2002-2012) and prospective (2012 onwards) recruitment with prospective follow-up, were reviewed to assess patient characteristics, imaging findings, and clinical outcomes according to the presence of LVT.

RESULTS

Of 1478 TTS consecutive patients (median age 72 years, 13.5 % men), 42 patients (2.8 %) presented with LVT. Presentation with syncope, a typical "apical ballooning" pattern, the presence of late gadolinium enhancement (LGE) on cardiac magnetic resonance imaging, and elevated high sensitivity-C reactive protein (hs-CRP), were associated with LVT. On multivariable analysis, elevated hs-CRP at admission and LGE persisted as independent predictors of LV thrombus. Patients with LVT had higher rates of in-hospital major bleeding (9.5 % vs. 3.1 %, p = 0.023) and major adverse cardiovascular events (26.8 % vs. 15.2 %, p = 0.035), mainly driven by stroke (14.6 % vs. 2.5 %, p < 0.001) and systemic embolism (19 % vs. 1.3 %, p < 0.001). At a median follow-up of 18 months, there were no differences in mortality, cardiac readmissions, or TTS recurrence between groups.

CONCLUSIONS

In TTS patients, elevated hs-CRP and LGE are associated with a higher risk of LVT. Although LVT is rare, it is associated with increased in-hospital thromboembolic events and bleeding, while long-term outcomes are comparable to those without LVT.