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Clin Res Cardiol (2022). https://doi.org/10.1007/s00392-022-02002-5 |
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| Incidence and Clinical Impact of Right Ventricular Involvement (Biventricular ballooning) in Takotsubo syndrome: Results from the GEIST Registry | ||
| I. El-Battrawy1, F. Santoro2, T. Stiermaier3, C. Möller4, F. Guastafierro2, G. Novo5, S. Novo5, M. Enrico6, F. Romeo6, H. Thiele7, F. Guerra8, A. Capucci8, N. D. Brunetti2, I. Eitel3, I. Akin9 | ||
| 1Medizinische Klinik II, Kardiologie und Angiologie, Berufsgenossenschaftlliches Universitätsklinikum Bergmannsheil, Bochum; 2Cardiology Medical Center Foggia, Foggia, IT; 3Medizinische Klinik II / Kardiologie, Angiologie, Intensivmedizin, Universitätsklinikum Schleswig-Holstein, Lübeck; 4Medizinische Klinik I, Leopoldina-Krankenhaus Schweinfurt, Schweinfurt; 5University of Palermo, Palermo, IT; 6University Tor Vergata Rome, Roma, IT; 7Klinik für Innere Medizin/Kardiologie, Herzzentrum Leipzig - Universität Leipzig, Leipzig; 8University of Ancona, Ancona, IT; 9I. Medizinische Klinik, Universitätsklinikum Mannheim, Mannheim; | ||
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Background: The short- and long-term prognosis of takotsubo syndrome (TTS) presenting with right ventricular (RV) involvement remains poorly understood. Research question: What is the incidence and clinical outcome of RV involvement in TTS? Study design and methods: We analyzed 839 consecutive TTS patients (758 females and 81 males) in a multicenter registry. RV involvement was defined as wall motion abnormality of the RV free wall, with or without apical involvement. The median long-term follow-up was 2.1 years (IQR 0.3-4.5 years). The primary outcome was in-hospital and out-of-hospital all-cause mortality. The secondary endpoint was a composite of in-hospital death, thromboembolic events, cardiogenic shock, pulmonary edema or malignant arrhythmias. Results: The incidence of RV involvement in TTS was 11% (n=93). More often patients with RV involvement were males compared to patients without RV involvement (p=0.02). There was a slight difference in the left ventricular ejection fraction measured in patients with RV involvement versus those patients with isolated left ventricular TTS (38±10% vs 40±10%, p=0.03). No major differences in terms of comorbidities were observed between groups except with regards to a history of cancer which was significantly more prevalent in TTS patients presenting with RV involvement (p=0.03). Physical stressors were more prevalent in the RV group (p<0.01), whereas emotional stressors were less prevalent (p<0.01). Patients with RV involvement had a higher incidence of in-hospital cardiogenic shock (p=0.02). The primary outcome (in- and out-of-hospital all-cause mortality) was observed in 12.8% of patients without RV involvement as compared to 29% of patients with RV involvement. Whereas the in-hospital mortality rate was similar in both groups, a higher out-of-hospital all-cause mortality rate (log-rank-test, p=0.008) was observed in the RV involvement group. The Cox multivariable regression analysis revealed physical triggers to be independent predictors of RV involvement. Interpretation: RV involvement defines a high-risk cohort of TTS patients.
Clinical trial registration: NCT04361994 |
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https://dgk.org/kongress_programme/jt2022/aV198.html |