Echocardiographic prognostic implications intako-tsubo cardiomyopathy. Insights from the takotsubo italian network (TIN)

Aim: To investigate the echocardiographic prognostic implications in patients (pts) with tako-tsubo cardiomyopathy (TTC). Methods: 110 consecutive pts (66.7±11.5 years; 91% females) enrolled in the TIN underwent echocardiography at hospital admission. Left ventricular ejection fraction (LVEF), wall motion score index (WMSI), mitral inflow, E/e’, mitral regurgitation (MR), left ventricular outflow tract (LVOT) obstruction ≥ 25 mmHg, right ventricular (RV) involvement, were systematically assessed at admission and discharge. Results: Apical and midventricular ballooning were detected in 100 (91%) and 10 (9%) pts respectively. LVOT obstruction (18 pts; 16.3%), ≥ moderate MR (16 pts; 14.5%), and RV involvement (15 pts; 13.6%), were reported. LVEF (from 37.65±6.11% to 54.47±8.01%; p<0.001), WMSI (from 1.75±0.26 to 1.24±0.22, p<0.001), LVESV (from 54.2±14 ml to 37.8±9.9 ml, p<0.001) and E/e’ (from 10.6±3.9 to 8.9±2.4, p<0.001) significantly improved from admission to discharge. Respiratory arrest (1pts, 0.9%), acute heart failure (20 pts, 18.2%), cardiogenic shock (12 pts, 10.9%), VT/VF (5pts, 4.5%), and cardiac death (5 pts, 4.5%) were reported during hospital stay. At univariate analysis WMSI [p=0.005, CI 11,23 (2.04-61.80)], ≥ moderate MR [p=0.029, CI 3.36 (1.13-9.96)] and E/e’ [p=0.003, CI 1,17 (1.05-1.31)] were associated with hard events. At multivariate analysis the only independent predictor of hard events was E/e’[p=0.003, CI 1,17 (1.05-1.30)]. Conclusions: Echocardiographic evaluation in the acute phase of TTC may recognize patients at higher risk of major cardiac complications.