TY - JOUR
T1 - Incidence, determinants and prognostic relevance of cardiogenic shock in patients with Takotsubo cardiomyopathy
AU - Stiermaier, Thomas
AU - Eitel, Charlotte
AU - Desch, Steffen
AU - Fuernau, Georg
AU - Schuler, Gerhard
AU - Thiele, Holger
AU - Eitel, Ingo
PY - 2016/1/1
Y1 - 2016/1/1
N2 - Background: Takotsubo cardiomyopathy (TTC) can be accompanied by various life-threatening complications, including cardiogenic shock. The exact incidence and prognostic relevance of cardiogenic shock in TTC patients has not been studied in detail. Methods: The frequency and determinants of cardiogenic shock were evaluated in 178 patients with TTC. The clinical course and treatment strategies of TTC patients with cardiogenic shock were systematically analysed. Furthermore, short and long-term mortality rates were assessed with a structured telephone follow-up. Results: The incidence of cardiogenic shock in this large TTC population was 12.4%. Multivariable logistic regression analysis identified left ventricular ejection fraction as the only significant predictor of cardiogenic shock (odds ratio 0.80; 95% confidence interval (CI) 0.73–0.88; P<0.01). The majority of the TTC patients with cardiogenic shock were treated with catecholamine therapy (86%) and 59% received early initiated mechanical circulatory support. TTC patients with cardiogenic shock showed significantly increased 28-day mortality rates compared to patients without cardiogenic shock (28.6% vs. 4.1%; relative risk 7.05, 95% CI 2.50–19.84; P<0.01). Furthermore, cardiogenic shock patients were at ongoing increased risk of death beyond the first 28 days resulting in considerably elevated 1-year (61.9% vs. 7.4%; P<0.01) and long-term mortality rates at 3.6 years of follow-up (66.7% vs. 19%; P<0.01). Conclusion: Cardiogenic shock is a frequent complication in TTC patients and is associated with increased short and long-term mortality rates. Patients at risk of developing cardiogenic shock may be identified by means of a severely impaired left ventricular function.
AB - Background: Takotsubo cardiomyopathy (TTC) can be accompanied by various life-threatening complications, including cardiogenic shock. The exact incidence and prognostic relevance of cardiogenic shock in TTC patients has not been studied in detail. Methods: The frequency and determinants of cardiogenic shock were evaluated in 178 patients with TTC. The clinical course and treatment strategies of TTC patients with cardiogenic shock were systematically analysed. Furthermore, short and long-term mortality rates were assessed with a structured telephone follow-up. Results: The incidence of cardiogenic shock in this large TTC population was 12.4%. Multivariable logistic regression analysis identified left ventricular ejection fraction as the only significant predictor of cardiogenic shock (odds ratio 0.80; 95% confidence interval (CI) 0.73–0.88; P<0.01). The majority of the TTC patients with cardiogenic shock were treated with catecholamine therapy (86%) and 59% received early initiated mechanical circulatory support. TTC patients with cardiogenic shock showed significantly increased 28-day mortality rates compared to patients without cardiogenic shock (28.6% vs. 4.1%; relative risk 7.05, 95% CI 2.50–19.84; P<0.01). Furthermore, cardiogenic shock patients were at ongoing increased risk of death beyond the first 28 days resulting in considerably elevated 1-year (61.9% vs. 7.4%; P<0.01) and long-term mortality rates at 3.6 years of follow-up (66.7% vs. 19%; P<0.01). Conclusion: Cardiogenic shock is a frequent complication in TTC patients and is associated with increased short and long-term mortality rates. Patients at risk of developing cardiogenic shock may be identified by means of a severely impaired left ventricular function.
UR - http://www.scopus.com/inward/record.url?scp=85053286048&partnerID=8YFLogxK
U2 - 10.1177/2048872615612456
DO - 10.1177/2048872615612456
M3 - Journal articles
C2 - 26474843
AN - SCOPUS:85053286048
SN - 2048-8726
VL - 5
SP - 489
EP - 496
JO - European Heart Journal: Acute Cardiovascular Care
JF - European Heart Journal: Acute Cardiovascular Care
IS - 6
ER -