Author + information
- Received July 6, 2013
- Revision received August 27, 2013
- Accepted September 5, 2013
- Published online February 1, 2014.
- Rodolfo Citro, MD∗,†∗ (, )
- Fausto Rigo, MD‡,
- Antonello D'Andrea, MD§,
- Quirino Ciampi, MD‖,
- Guido Parodi, MD¶,
- Gennaro Provenza, MD#,
- Raffaele Piccolo, MD∗∗,
- Marco Mirra, MD††,
- Concetta Zito, MD‡‡,
- Roberta Giudice, MD††,
- Marco Mariano Patella, MD§§,
- Francesco Antonini-Canterin, MD‖‖,
- Eduardo Bossone, MD†,
- Federico Piscione, MD††,
- Jorge Salerno-Uriarte, MD∗,
- Tako-Tsubo Italian Network Investigators
- ∗Department of Heart Sciences, Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy
- †Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy
- ‡Department of Cardiology, Dell'Angelo Hospital, Mestre, Italy
- §Department of Cardiology, Second University of Naples, Naples, Italy
- ‖Department of Cardiology, Fatebenefratelli Hospital, Benevento, Italy
- ¶Division of Cardiology, Careggi Hospital, Florence, Italy
- #Division of Cardiology, Civic Hospital, Villa d'Agri, Potenza, Italy
- ∗∗Department of Clinical Medicine, Cardiovascular Sciences and Immunology, Federico II, University of Naples, Naples, Italy
- ††Department of Medicine and Surgery, University of Salerno, Salerno, Italy
- ‡‡Division of Cardiology, University of Messina, Messina, Italy
- §§Division of Cardiology, S. Maria Hospital, Terni, Italy
- ‖‖Division of Cardiology, S. Maria degli Angeli Hospital, Pordenone, Italy
- ↵∗Reprint requests and correspondence:
Dr. Rodolfo Citro, Department of Heart Sciences, Experimental and Clinical Physiology Institute, University of Insubria, Varese, Italy, and University Hospital San Giovanni di Dio e Ruggi d'Aragona, Heart Tower Room 810, Largo Città di Ippocrate, 84131 Salerno, Italy.
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.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received July 6, 2013.
- Revision received August 27, 2013.
- Accepted September 5, 2013.
- American College of Cardiology Foundation