Author + information
- Received April 13, 2018
- Revision received May 4, 2018
- Accepted May 17, 2018
- Published online October 29, 2018.
- Manuel Almendro-Delia, MD, PhDa,∗ ( )(, )
- Iván J. Núñez-Gil, MD, PhDb,
- Manuel Lobo, MDa,
- Mireia Andrés, MDc,
- Oscar Vedia, MDb,
- Alessandro Sionis, MD, PhDd,
- Ana Martin-García, MD, PhDe,
- María Cruz Aguilera, MDf,
- Eduardo Pereyra, MDg,
- Irene Martín de Miguel, MDh,
- José A. Linares Vicente, MDi,
- Miguel Corbí-Pascual, MDj,
- Xavier Bosch, MDk,
- Oscar Fabregat Andrés, MDl,
- Alejandro Sánchez Grande Flecha, MDm,
- Alberto Pérez-Castellanos, MDn,
- Javier López Pais, MDo,
- Manuel De Mora Martín, MDp,
- Juan María Escudier Villa, MDq,
- Roberto Martín Asenjo, MDr,
- Marta Guillen Marzo, MDs,
- Ferrán Rueda Sobella, MDt,
- Álvaro Aceña, MDu,
- José María García Acuña, MDv,
- Juan C. García-Rubira, MD, PhDa,
- for the RETAKO Investigators
- aUnidad Coronaria, Servicio de Cardiología, Hospital Virgen Macarena, Sevilla, Spain
- bInstituto Cardiovascular, Hospital Clínico San Carlos, Madrid, Spain
- cServicio de Cardiología, Hospital Universitario Vall d'Hebron, Barcelona, Spain
- dUnidad de Cuidados Intensivos Cardiológicos, Servicio de Cardiología, Hospital de la Santa Creu i Sant Pau, Instituto de Investigación Biomédica Sant Pau (IIB Sant Pau), Barcelona, Spain
- eS. Cardiología, Hospital Universitario de Salamanca-IBSAL-CIBERCV, Salamanca, Spain
- fS. Cardiología, Hospital de la Princesa, Madrid, Spain
- gS. Cardiología, Hospital Universitario Arnau de Vilanova, Lérida, Spain
- hS. Cardiología, Hospital General Universitario Gregorio Marañón, Madrid, Spain
- iS. Cardiología, Hospital Clínico Lozano Blesa, Zaragoza, Spain
- jServicio de Cardiología, Hospital Universitario de Albacete, Albacete, Spain
- kUnidad de Cuidados Cardiacos Agudos, Servicio de Cardiología, Hospital Clinic, IDIBAPS, Universidad de Barcelona, Barcelona, Spain
- lServicio de Cardiología, Hospital General Universitario de Valencia, Valencia, Spain
- mServicio de Cardiología, Hospital Universitario de Canarias, Tenerife, Spain
- nServicio de Cardiología, Hospital de Manacor, Baleares, Spain
- oServicio de Cardiología, Hospital Universitario de Getafe, Madrid, Spain
- pServicio de Cardiología, Hospital Carlos Haya, Málaga, Spain
- qServicio de Cardiología, Hospital Puerta de Hierro, Madrid, Spain
- rServicio de Cardiología, Hospital 12 de Octubre, Madrid, Spain
- sServicio de Cardiología, Hospital Joan XXIII, Tarragona, Spain
- tServicio de Cardiología, Hospital Universitario Germans Trias i Pujol, Badalona, Spain
- uServicio de Cardiología, Fundación Jiménez Díaz, Madrid, Spain
- vServicio de Cardiología, Hospital Clínico Universitario de Santiago, Santiago, Spain
- ↵∗Address for correspondence:
Dr. Manuel Almendro-Delia, Cardiovascular Care Unit, Cardiology Department, Virgen Macarena University Hospital, Avd Dr. Fedriani 3, 41071, Seville. Spain.
Objectives This study sought to describe the incidence, determinants, and prognostic impact of cardiogenic shock (CS) in takotsubo syndrome (TTS).
Background TTS can be associated with severe hemodynamic instability. The prognostic implication of CS has not been well characterized in large studies of TTS.
Methods We analyzed patients with a definitive TTS diagnosis (modified Mayo criteria) who were recruited for the National RETAKO (Registry on Takotsubo Syndrome) trial from 2003 to 2016. Cox and competing risk regression models were used to identify factors associated with mortality and recurrences.
Results A total of 711 patients were included, 81 (11.4%) of whom developed CS. Male sex, QTc interval prolongation, lower left ventricular ejection fraction at admission, physical triggers, and presence of “a significant” left intraventricular pressure gradient, were associated with CS (C index = 0.85). In-hospital complication rates, including mortality, were significantly higher in patients with CS. Over a median follow-up of 284 days (interquartile range: 94 to 929 days), CS was the strongest independent predictor of long-term, all-cause mortality (hazard ratio [HR]: 5.38; 95% confidence interval [CI]: 2.60 to 8.38); cardiovascular (CV) death (sub-HR: 4.29; 95% CI: 2.40 to 21.2), and non-CV death (sub-HR: 3.34; 95% CI: 1.70 to 6.53), whereas no significant difference in the recurrence rate was observed between groups (sub-HR: 0.76; 95% CI: 0.10 to 5.95). Among patients with CS, those who received beta-blockers at hospital discharge experienced lower 1-year mortality compared with those who did not receive a beta-blocker (HR: 0.52; 95% CI: 0.44 to 0.79; pinteraction = 0.043).
Conclusions CS is not uncommon and is associated with worse short- and long-term prognosis in TTS. CS complicating TTS may constitute a marker of underlying disease severity and could identify a masked heart failure phenotype with increased vulnerability to catecholamine-mediated myocardial stunning.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
- Received April 13, 2018.
- Revision received May 4, 2018.
- Accepted May 17, 2018.
- 2018 American College of Cardiology Foundation
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