Introduction
TTS has been considered a disease with relative benign prognosis since it was first described in 1990. In the last years it is proven that in-hospital mortality of TTS is like that of ACS (Templin C et al., 2015). Furthermore, long-term outcomes are also similar in patients with TTS compared with patients with myocardial infarction (Tornvall P et al.,2016, Stiermaier T et al.,2016, Ghadri JR et al., 2018a).
Aim if the study
Aim of the study is to determine the role of various parameters at admission as survival predictors, giving evidence that suggest which patients are initially at high risk and to investigate if there are baseline parameters in Takotsubo patients affecting short and long term prognosis.
Methods
43 TTS patients hospitalized in Ingolstadt hospital between the years 2013-2019 were included in the study and remained under consistent follow-up for major cardiac adverse events (MACEs), medication and functional status throughout the whole duration of the study. After patient recruitment, data regarding their initial hospitalization for TTS treatment were collected and registered. These data included demographics, clinical and laboratory parameters, ECG and echocardiographic data. All patients were followed retrospectively for the years till enrollment and prospectively after enrollment for major adverse cardiac events, functional status, and medication. Follow-up was consistent until completion of registry in February 2021.
Results
Baseline characteristics
Table 1 shows the baseline characteristics for the overall TTS patients’ group. Most individuals were females (90.7%) while mean age was 72.16 years and BMI equal to 26.64. Regarding Takotsubo cause, 37.2% of individuals had emotional Takotsubo cause.
|
Baseline Characteristics |
|
|
|
|
Mean (sd) |
Median (IQR) |
|
Age (years) |
72.16 (9.84) |
70.0 (65.0, 80.0) |
|
BMI |
26.64 (5.12) |
26.0 (22.3, 30.29) |
|
|
N (%) |
|
|
Gender (Females) |
39 (90.7) |
|
|
Takotsubo Cause |
|
|
|
Emotional |
16 (37.2) |
|
|
Physical |
27 (37.2) |
|
|
Unknown |
11 (25.6) |
|
Table 2 shows the baseline the echocardiographic parameters for the patient group. Median EF was found equal to 45.0 %.
|
Parameters |
|
|
|
|
Mean (sd) |
Median (IQR) |
|
EF, median (IQR) |
46.6 (9.64) |
45.0 (40.0, 55.0) |
|
|
N (%) |
|
Statistical analysis
Table 3 shows the relationship between Takotsubo cause and death occurrence. There is a significant relationship between Cause and death (p=0.035). All deaths occurred in the “other” cause category.
|
|
Death, n (%) |
|
|
Cause |
No |
Yes |
p |
|
Emotional |
16 (100.0) |
0(0.0) |
0.035
|
|
Other |
20(74.0) |
7 (26.0) |
Cox regression was used to investigate the association between the survival time of patient group and one or more predictor variables. Results from cox regression for each variable independently are shown in Table 4.
|
Baseline Characteristics |
|
|
HR (95%CI) |
p |
|
Gender (Females) |
0.131 (0.011, 1.520) |
0.104 |
|
Age |
1.024 (0.943, 1.113) |
0.571 |
|
Baseline EF |
0.832 (0.717, 0.966) |
0.016 |
|
Troponin |
1.000 (0.999, 1.000) |
0.553 |
One significant association was found for baseline EF which indicates that for one unit decrease in follow- up EF, the risk of death increases by about 20% [HR (95%CI) = 0.832 (0.717, 0.966), p=0.016].
Conclusion
TTS patients with triggering factor an emotional cause have better prognosis in comparison to patients with triggering factors other causes, which showed an increased mortality. Reduced EF in acute phase was found to be the only factor associated with worse outcome regarding mortality in survival analysis.