Clinical and echocardiographic correlates of acute heart failure, cardiogenetic shock and in-hospital mortality in tako-tsubo cardiomyopathy: insights from the “Tako-tsubo Italian Network”.

Objective: 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; female 90.3%) enrolled in the Tako-tsubo Italian Network, undergoing transthoracic two-dimensional echocardiography on admission and at short-term follow-up [4.3 (4-6) 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%). Elderly patients aged ≥75 years (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; p<0.001), LV outflow tract obstruction (23.7 vs 8.9%, p=0.006), pulmonary artery systolic pressure (47.4 ± 12.3 vs 38.0 ± 9.2 mmHg; 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: 0.89-0.95; p<0.001), E/e’ ratio (HR 1.13; 95%CI: 1.02-1.24; p=0.011), reversible moderate to severe mitral regurgitation (HR 3.25; 95%CI: 1.16-9.10; p=0.025), and age ≥75 years (HR 2.81; 95%CI: 1.05-7.52; 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 in identifying patients at higher risk of hemodynamic deterioration and poor in-hospital outcome, allowing prompt institution of appropriate pharmacological treatment and adequate mechanical support.