Echocardiographic Correlates of Acute Heart Failure, Cardiogenic Shock, and In-Hospital Mortality in Tako-Tsubo Cardiomyopathy

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• 作者：Rodolfo Citro ; Fausto Rigo ; Antonello D'Andrea ; Quirino Ciampi ; Guido Parodi ; Gennaro Provenza ; Raffaele Piccolo ; Marco Mirra ; Concetta Zito ; Roberta Giudice ; Marco Mariano Patella ; Francesco Antonini-Canterin ; Eduardo Bossone ; Federico Piscione ; Jorge Salerno-Uriarte ; Tako-Tsubo Italian Network Investigators
• 关键词：acute heart failure ; cardiogenic shock ; echocardiography ; stress cardiomyopathy ; tako-tsubo cardiomyopathy
• 刊名：JACC: Cardiovascular Imaging
• 出版年：February, 2014
• 年：2014
• 卷：7
• 期：2
• 页码：119-129
• 全文大小：319 K

文摘

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Objectives

The purpose of this study was 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 卤 12.2 years of age; females, 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 to 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%). The variables for elderly patients 鈮?5 years of age (42.4% vs. 23.8%; p聽= 0.011): left ventricular (LV) ejection fraction (35.1 卤 5.9% vs. 38.4 卤 4.6%, p聽< 0.001), wall motion score index (1.9 卤 0.2 vs. 1.7 卤 0.2, p < 0.001), E/e鈥?ratio (13.5 卤 4.3 vs. 9.9 卤 3.3 [where E/e鈥?is ratio of mitral E peak velocity and averaged e鈥?velocity], p < 0.001), LV outflow tract obstruction (23.7 vs. 8.9%, p聽= 0.006), pulmonary artery systolic pressure (47.4 卤 12.3 mm Hg vs. 38.0 卤 9.2 mm Hg; p聽<聽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 to 0.95; p < 0.001), E/e鈥?ratio (HR: 1.13; 95% CI: 1.02 to 1.24; p聽= 0.011), reversible moderate to severe mitral regurgitation (HR: 3.25; 95% CI: 1.16 to 9.10; p聽= 0.025), and age 鈮?5 years (HR: 2.81; 95% CI: 1.05 to 7.52; p聽= 0.039) were independent correlates of major adverse events.

Conclusions

Echocardiographic parameters provide additional information compared to other variables routinely used in clinical practice to identify patients at higher risk of hemodynamic deterioration and poor in-hospital outcome, allowing prompt institution of appropriate pharmacological treatment and adequate mechanical support.