December 11, 2018
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Cardiogenic shock confers worse outcomes in takotsubo cardiomyopathy

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Among patients with takotsubo cardiomyopathy, cardiogenic shock was linked to worse short- and long-term outcomes, according to a study published in JACC: Heart Failure.

Manuel Almendro-Delia, MD, PhD, an acute care cardiologist at Hospital Virgen Macarena in Sevilla, Spain, and colleagues analyzed data from 711 patients (mean age, 70 years; 13% men) from the RETAKO trial with a definitive takotsubo cardiomyopathy diagnosis between 2003 and 2016. A dedicated electronic case report form was used to collect information on baseline patient characteristics, in-hospital course, triggering factors, short- and long-term outcomes, and pharmacological treatment by the attending physician.

Follow-up after hospital discharge consisted of structured telephone interviews or outpatient clinical visits. Outcomes of interest were first nonfatal takotsubo cardiomyopathy recurrence and/or all-cause mortality.

During a median follow-up of 284 days, 11.4% of patients developed cardiogenic shock. Factors associated with cardiogenic shock included corrected QT interval prolongation (OR = 1.95; 95% CI, 1.17-3.24), male sex (OR = 2.52; 95% CI, 1.15-6.32), physical triggers (OR = 2.45; 95% CI, 1.05-5.68), lower left ventricular ejection fraction at admission (OR per 10% increase = 0.29; 95% CI, 0.18-0.47) and the presence of a significant left intraventricular pressure gradient (OR = 4.62; 95% CI, 1.46-14.62).

Patients with cardiogenic shock were more likely to have in-hospital complications, including infections (50%), death (13.6%), ventricular arrhythmias (12%), acute kidney failure (36%) and new-onset atrial fibrillation (30%).

During follow-up, cardiogenic shock was the strongest independent predictor of CV death (sub-HR = 4.29; 95% CI, 2.4-21.2), non-CV death (sub-HR = 3.34; 95% CI, 1.7-6.53) and all-cause mortality (HR = 5.38; 95% CI, 2.6-8.38).

Patients with cardiogenic shock who received beta-blockers when they were discharged from the hospital had a lower rate of mortality at 1 year vs. those who did not receive a beta-blocker (HR = 0.52; 95% CI, 0.44-0.79; P for interaction = .043).

“[Cardiogenic shock] complicating [takotsubo cardiomyopathy] may constitute a marker of underlying disease severity and could identify a masked heart failure phenotype with increased vulnerability to catecholamine-mediated myocardial stunning,” Almendro-Delia and colleagues wrote. – by Darlene Dobkowski

Disclosures: The authors report no relevant financial disclosures.