Impact of residual inflammation on myocardial recovery and cardiovascular outcome in Takotsubo patients
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
DOI:
10.1002/ehf2.12945
Publication Date:
2020-11-18T23:52:09Z
AUTHORS (17)
ABSTRACT
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.
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