LV Function Recovery and Outcomes in Takotsubo Syndrome

Sep 20, 2024
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Authors:
Almendro-Delia M, López-Flores L, Uribarri A, et al., on behalf of the RETAKO Investigators.
Citation:
Recovery of Left Ventricular Function and Long-Term Outcomes in Patients With Takotsubo Syndrome. J Am Coll Cardiol 2024;84:1153-1174.
Summary By:
Bina Ahmed, MD, FACC

Quick Takes

  • This current retrospective analysis from the RETAKO registry (Spain and South America) of patients with Takotsubo syndrome aimed to define predictors of late LV function recovery and impact of early (<10 days) or late (>10 days) LV function recovery on mortality (n = 1,463).
  • The majority of patients had early recovery (75%). Older age, history of neurological disorders, coronary artery disease, active cancer, physical triggers, elevated inflammatory biomarkers, cardiogenic shock, and lower LVEF at admission were independent predictors of late LV function recovery.
  • Delayed LV function recovery was associated with higher long-term mortality compared to patients who had early recovery of LV function (16.0% vs. 8.6%, adjusted HR, 1.31; 95% CI, 1.12-1.60).

Study Questions:

What are the predictors and what is the prognostic impact of time-to-left ventricular (LV) recovery after Takotsubo syndrome (TTS)?

Methods:

Prospective serial imaging data from the nationwide, multicenter RETAKO (REgistry on TAKOtsubo Syndrome) were comprehensively reviewed to assess the timing of LV recovery. Multivariable logistic regression was used to assess factors associated with late (>10 days) versus early (<10 days) recovery. The long-term risk of all-cause mortality was compared between the late and early recovery groups using fully adjusted Cox models, and using flexible parametric survival models with recovery time included as a continuous variable.

Results:

Of 1,463 patients included (median age 73 years, 13% men), 373 (25%) had late and 1,090 (75%) had early LV recovery. Older age, history of neurological disorders, bystander coronary artery disease, active cancer, physical triggers, elevated inflammatory biomarkers, cardiogenic shock, and lower LV ejection fraction (LVEF) at admission were independent predictors of late recovery. At 4-year follow-up, the adjusted risk of death was significantly higher in patients with late recovery compared with those with early recovery (16.0% vs. 8.6%, adjusted hazard ratio [aHR], 1.31; 95% confidence interval [CI], 1.12-1.60), with the risk of death increasing by 8% for every additional 10-day delay in time-to-LV recovery (aHR, 1.08; 95% CI, 1.04-1.13).

Conclusions:

Late recovery of LV function after TTS is associated with reduced short- and long-term survival. In TTS patients without early LV recovery, closer clinical follow-up might be considered.

Perspective:

This current retrospective analysis from the RETAKO registry (Spain and South America) of patients with TTS aimed to define predictors of late LV function recovery and impact of early (<10 days) or late (>10 days) LV function recovery on mortality. The majority of patients had early recovery (75%). Older age, history of neurological disorders, coronary artery disease, active cancer, physical triggers, elevated inflammatory biomarkers, cardiogenic shock, and lower LVEF at admission were independent predictors of late LV function recovery. Delayed LV function recovery was associated with higher long-term mortality compared to patients who had early recovery of LV function (16.0% vs. 8.6%, aHR, 1.31; 95% CI, 1.12-1.60). Optimal management of patients with delayed LV function recovery after TTS remains to be defined and this patient group may benefit from closer follow-up after the index event.

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Heart Failure, Takotsubo Cardiomyopathy, Ventricular Function, Left


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