You are here

  • Home
  • Online First
  • Left ventricular outflow tract obstruction in Takotsubo syndrome with cardiogenic shock: prognosis and treatment

Article Text

Article menu
Download PDFPDF
Heart failure and cardiomyopathies
Original research
Left ventricular outflow tract obstruction in Takotsubo syndrome with cardiogenic shock: prognosis and treatment
  1. Sofía Vila-Sanjuán1,2,
  2. Ivan Javier Nuñez-Gil3,4,
  3. Oscar Vedia5,
  4. Miguel Corbi-Pascual6,
  5. Jorge Salamanca7,
  6. Manuel Martinez-Selles8,
  7. Emilia Blanco9,
  8. Manuel Almendro-Delia10,
  9. Alberto Pérez-Castellanos11,
  10. Agustin C Martin-Garcia12,
  11. Marco Tomasino1,
  12. Ravi Vazirani13,
  13. Clara Fernández-Cordón14,
  14. Albert Duran Cambra15,
  15. Víctor Manuel Becerra-Muñoz16,
  16. Marta Guillén17,
  17. Juan Albistur Reyes18,
  18. Aitor Uribarri1,2,19,20
  1. 1Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Spain
  2. 2Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
  3. 3Cardiology, Hospital Clinico San Carlos, Madrid, Spain
  4. 4Cardiology Department, Hospital Universitario de Torrejón, Madrid, Spain
  5. 5Hospital Clinico San Carlos, Madrid, Spain
  6. 6Cardiology, Hospital General de Albacete, Albacete, Spain
  7. 7Cardiology, Hospital Universitario de la Princesa, Madrid, Spain
  8. 8Cardiologya, Gregorio Maranon General University Hospital Cardiology Service, Madrid, Spain
  9. 9Arnau de Vilanova University Hospital, Lleida, Spain
  10. 10Cardiology, Hospital Universitario Virgen Macarena, Sevilla, Spain
  11. 11Hospital Son Dureta, Palma, Spain
  12. 12Hospital Clinico de Salamanca, Salamanca, Spain
  13. 13Cardiology, Hospital Clínico San Carlos, Madrid, Spain
  14. 14Cardiology, Hospital Clínico Universitario de Valladolid, Valladolid, Spain
  15. 15Cardiologia, Hospital de la Santa Creu i Sant Pau, Barcelona, Spain
  16. 16Hospital Virgen de la Victoria Unidad de Gestión Clínica del Corazón y Patología Cardiovascular, Malaga, Spain
  17. 17Cardiology, Joan XXIII University Hospital in Tarragona, Tarragona, Spain
  18. 18Hospital de Clinicas Doctor Manuel Quintela, Montevideo, Uruguay
  19. 19CIBER-CV, Madrid, Spain
  20. 20VHIR - Vall d'Hebron Institut de Recerca, Barcelona, Spain
  1. Correspondence to Dr Aitor Uribarri, Cardiology Department, Hospital Universitari Vall d'Hebron, Barcelona, Catalunya, Spain; auribarrig{at}gmail.com

Abstract

Background Patients with Takotsubo syndrome (TTS) who develop cardiogenic shock may present with left ventricular outflow tract obstruction (LVOTO). The prognosis and treatment of this population have not been defined in previous studies. The aim of this study is to describe the clinical presentation, management, evolution and prognosis of a subgroup of patients with TTS and cardiogenic shock according to whether they present with LVOTO or not.

Methods We analysed patients with TTS recruited from 2003 to 2022 in a multicentre registry. Patients were selected if they presented cardiogenic shock during their admission. This analysis was compared according to the presence or absence of LVOTO.

Results 322 patients were included, 58 (18%) of whom had LVOTO. The majority were treated with vasoactive and inotropic therapy (VIT) and its use was strongly associated with having LVOTO (77.6% vs 57.6%, p<0.001). Only five (3.3%) patients without LVOTO and two (4.4%) in the LVOTO group treated with VIT developed or worsened the obstruction. Furthermore, patients with LVOTO presented higher in-hospital complications including ventricular arrhythmias (15.5% vs 8.7%, p=0.017), major bleeding (13.8% vs 6.1%, p=0.042) and acute kidney failure (48.3% vs 28.4%, p=0.003). However, at both 90 days and 5 years, the cumulative incidence of all-cause death was not significantly different between the patients with and without LVOTO (HR 1.20, 95% CI 0.60 to 2.40 for 90 days, and HR 1.69, 95% CI 0.89 to 3.21 for 5 years).

Conclusions LVOTO is not uncommon in patients with TTS and cardiogenic shock. It is associated with a more aggressive in-hospital course and our data is unable to rule out an association between the presence of LVOTO and long-term prognosis of patients with TTS. The development or worsening of LVOTO directly related to inotropic or vasoactive support was low.

  • CARDIOGENIC SHOCK
  • Mitral Valve Insufficiency

Data availability statement

Data are available upon reasonable request.

https://doi.org/10.1136/heartjnl-2024-324205

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    Data availability statement

    Data are available upon reasonable request.

    View Full Text

    Footnotes

    • X @DrRaviVazirani, @auribarri

    • Contributors SV-S and AU wrote the statistical analysis plan, cleaned and analysed the data and drafted and revised the paper. IJN-G is the national registry coordinator and is responsible for its information. OV, MC-P, JS, MM-S, EB, MA-D, AP-C, ACM-G, MT, RV, CF-C, ADC, VMB-M, MG and JAR are local investigators and are responsible for ensuring accurate patient information at each of their centres. AU is responsible for the overall content as guarantor. All have collaborated in manuscript review.

    • Funding The RETAKO registry is maintained thanks to the support by a non-conditional Fundación Investigación Cardiovascular (FIC) scholarship.

    • Competing interests None declared.

    • Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting, or dissemination plans of this research.

    • Provenance and peer review Not commissioned; externally peer reviewed.

    • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

    Linked Articles