Impact of residual inflammation on myocardial recovery and cardiovascular outcome in Takotsubo patients

• DOI: 10.1002/ehf2.12945
• Publication Date: 2020-11-18T23:52:09Z
• Authors: Lucie Lachmet‐The...; Benjamin Marchandot; Kensuke Matsushita; Chisato Sato; Charlotte Dagrenat; Stephane Greciano; Fabien De Poli; Pierre Leddet; Marilou Peillex; Sébastien Hess; Adrien Carmona; Charline Jimenez; Joe Heger; Antje Reydel; Patrick Ohlmann; Laurence Jesel; Olivier Morel
• Keywords: Inflammation; 0301 basic medicine; Late cardiovascular outcome; Stroke Volume; Residual high inflammatory response; Prognosis; Ventricular Function, Left; [SDV.MHEP.CSC] Life Sciences [q-bio]/Human health and pathology/Cardiology and cardiovascular system; 3. Good health; Systemic inflammatory response syndrome; 03 medical and health sciences; 0302 clinical medicine; [SDV.SPEE] Life Sciences [q-bio]/Santé publique et épidémiologie; RC666-701; Original Research Articles; Diseases of the circulatory (Cardiovascular) system; Humans; Late cardiac death; Takotsubo syndrome; Predictive factor; Retrospective Studies

AbstractAimsRecent insights have emphasized the importance of myocardial and systemic inflammation in Takotsubo syndrome (TTS). In a large registry of unselected patients, we sought to evaluate whether residual high inflammatory response (RHIR) could impact cardiovascular outcome after TTS.Methods and resultsPatients with TTS were retrospectively included between 2008 and 2018 in three general hospitals. Three hundred eighty‐five patients with TTS were split into three subgroups, according to tertiles of C‐reactive protein (CRP) levels at discharge (CRP <5.2 mg/L, CRP range 5.2 to 19 mg/L, and CRP >19 mg/L). The primary endpoint was the impact of RHIR, defined as CRP >19 mg/L at discharge, on cardiac death or hospitalization for heart failure.Follow up was obtained in 382 patients (99%) after a median of 747 days. RHIR patients were more likely to have a history of cancer or a physical trigger. Left ventricular ejection fraction (LVEF) at admission and at discharge were comparable between groups. By contrast, RHIR was associated with lower LVEF at follow up (61.7% vs. 60.7% vs. 57.9%; P = 0.004) and increased cardiac late mortality (0% vs. 0% vs. 10%; P = 0.001). By multivariate Cox regression analysis, RHIR was an independent predictor of cardiac death or hospitalization for heart failure (hazard ratio: 1.87; 95% confidence interval: 1.08 to 3.25; P = 0.025).ConclusionsResidual high inflammatory response was associated with impaired LVEF at follow up and was evidenced as an independent factor of cardiovascular events. All together, these findings underline RHIR patients as a high‐risk subgroup, to target in future clinical trials with specific therapies to attenuate RHIR.