International Journal of Heart Failure

The Korean Society of Heart Failure (대한심부전학회)
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C-Reactive Protein Can Predict Outcomes in Patients With Takotsubo Syndrome

  • Gassan Moady (Department of Cardiology, Galilee Medical Center) ;
  • BateL Yelin (Azrieli Faculty of Medicine, Bar Ilan University) ;
  • Rania Sweid (Biostatistics Unit, Galilee Medical Center) ;
  • Shaul Atar (Department of Cardiology, Galilee Medical Center)
  • Received : 2023.06.17
  • Accepted : 2023.09.26
  • Published : 2024.01.31
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Abstract

Background and Objectives: Takotsubo syndrome (TTS) is a form of reversible cardiomyopathy often preceded by mental or physical stressors and predominantly affects elderly women. Several cardiac and inflammatory biomarkers are involved in the pathogenesis of the disease. We aimed to investigate the correlation of C-reactive protein (CRP) level with left ventricular ejection fraction (LVEF) and clinical outcomes in patients with TTS. Methods: The study included patients with discharge-diagnosis of Takotsubo through 2017-2022 from the cardiology department. Demographic, laboratory, echocardiographic, and clinical outcomes were retrospectively obtained. We investigated the relation between CRP and LVEF, length of stay (LOS), in-hospital complications, and recurrence. Results: A total of 86 patients (93% female, mean age 68.8±12.3 years) were included in the study. The median CRP level was 17.4 (interquartile range [IQR], 6.1-40.1) mg/L, and the mean LVEF was 41.5%, (IQR, 38-50%). Complications occurred in 24 (27.9%) of the patients, and the median LOS was 3 (IQR, 3-5) days. The level of CRP was associated with lower LVEF (r=-0.39, p<0.001), longer hospital stay (r=0.25, p=0.021), and recurrence. There was no correlation between CRP and in-hospital complications. In multivariate logistic regression, poor LVEF was associated with TTS recurrence (odds ratio, 1.22; 95% confidence interval, 1.08-1.37; p=0.001). Using linear regression, only CRP was correlated with longer LOS and lower LVEF (p<0.001). Conclusions: Among patients hospitalized with TTS, CRP level was associated with poor LVEF and prolonged hospital stay but not with in-hospital complications. Poor LVEF was also associated with TTS recurrence.

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References

  1. Templin C, Ghadri JR, Diekmann J, et al. Clinical features and outcomes of Takotsubo (stress) cardiomyopathy. N Engl J Med 2015;373:929-38.
  2. Medina de Chazal H, Del Buono MG, Keyser-Marcus L, et al. Stress cardiomyopathy diagnosis and treatment: JACC state-of-the-art review. J Am Coll Cardiol 2018;72:1955-71.
  3. Hurst RT, Prasad A, Askew JW 3rd, Sengupta PP, Tajik AJ. Takotsubo cardiomyopathy: a unique cardiomyopathy with variable ventricular morphology. JACC Cardiovasc Imaging 2010;3:641-9.
  4. Kurowski V, Kaiser A, von Hof K, et al. Apical and midventricular transient left ventricular dysfunction syndrome (Tako-Tsubo cardiomyopathy): frequency, mechanisms, and prognosis. Chest 2007;132:809-16.
  5. Haghi D, Papavassiliu T, Fluchter S, et al. Variant form of the acute apical ballooning syndrome (Takotsubo cardiomyopathy): observations on a novel entity. Heart 2006;92:392-4.
  6. Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J 2008;155:408-17.
  7. Ghadri JR, Cammann VL, Jurisic S, et al.; InterTAK co-investigators. A novel clinical score (InterTAK Diagnostic Score) to differentiate Takotsubo syndrome from acute coronary syndrome: results from the International Takotsubo Registry. Eur J Heart Fail 2017;19:1036-42.
  8. Ghadri JR, Wittstein IS, Prasad A, et al. International expert consensus document on Takotsubo syndrome (Part I): clinical characteristics, diagnostic criteria, and pathophysiology. Eur Heart J 2018;39:2032-46. 
  9. Redfors B, Jha S, Thorleifsson S, et al. Short- and long-term clinical outcomes for patients with Takotsubo syndrome and patients with myocardial infarction: a report from the Swedish Coronary Angiography and Angioplasty Registry. J Am Heart Assoc 2021;10:e017290.
  10. Ghadri JR, Kato K, Cammann VL, et al. Long-term prognosis of patients with Takotsubo syndrome. J Am Coll Cardiol 2018;72:874-82.
  11. Ahmed KA, Madhavan M, Prasad A. Brain natriuretic peptide in apical ballooning syndrome (Takotsubo/stress cardiomyopathy): comparison with acute myocardial infarction. Coron Artery Dis 2012;23:259-64.
  12. Paur H, Wright PT, Sikkel MB, et al. High levels of circulating epinephrine trigger apical cardiodepression in a β2-adrenergic receptor/Gi-dependent manner: a new model of Takotsubo cardiomyopathy. Circulation 2012;126:697-706.
  13. Randhawa MS, Dhillon AS, Taylor HC, Sun Z, Desai MY. Diagnostic utility of cardiac biomarkers in discriminating Takotsubo cardiomyopathy from acute myocardial infarction. J Card Fail 2014;20:377.e25-31.
  14. Madhavan M, Borlaug BA, Lerman A, Rihal CS, Prasad A. Stress hormone and circulating biomarker profile of apical ballooning syndrome (Takotsubo cardiomyopathy): insights into the clinical significance of B-type natriuretic peptide and troponin levels. Heart 2009;95:1436-41.
  15. Pelliccia F, Kaski JC, Crea F, Camici PG. Pathophysiology of Takotsubo syndrome. Circulation 2017;135:2426-41.
  16. Scally C, Abbas H, Ahearn T, et al. Myocardial and systemic inflammation in acute stress-induced (Takotsubo) cardiomyopathy. Circulation 2019;139:1581-92.
  17. Ancona F, Bertoldi LF, Ruggieri F, et al. Takotsubo cardiomyopathy and neurogenic stunned myocardium: similar albeit different. Eur Heart J 2016;37:2830-2.
  18. Godsman N, Kohlhaas M, Nickel A, et al. Metabolic alterations in a rat model of Takotsubo syndrome. Cardiovasc Res 2022;118:1932-46.
  19. Morel O, Sauer F, Imperiale A, et al. Importance of inflammation and neurohumoral activation in Takotsubo cardiomyopathy. J Card Fail 2009;15:206-13.
  20. Lachmet-Thebaud L, Marchandot B, Matsushita K, et al. Impact of residual inflammation on myocardial recovery and cardiovascular outcome in Takotsubo patients. ESC Heart Fail 2021;8:259-69.
  21. Wilson HM, Cheyne L, Brown PA, et al. Characterization of the myocardial inflammatory response in acute stress-induced (Takotsubo) cardiomyopathy. JACC Basic Transl Sci 2018;3:766-78.
  22. Nef HM, Mollmann H, Kostin S, et al. Tako-Tsubo cardiomyopathy: intraindividual structural analysis in the acute phase and after functional recovery. Eur Heart J 2007;28:2456-64.
  23. Kawai S, Suzuki H, Yamaguchi H, et al. Ampulla cardiomyopathy ('Takotusbo' cardiomyopathy)--reversible left ventricular dysfunction: with ST segment elevation. Jpn Circ J 2000;64:156-9.
  24. Mirijello A, D'Errico MM, Curci S, et al. Takotsubo syndrome and inflammatory bowel diseases: does a link exist? Dig Dis 2020;38:204-10.
  25. Serzan M, Rapisuwon S, Krishnan J, Chang IC, Barac A. Takotsubo cardiomyopathy associated with checkpoint inhibitor therapy: endomyocardial biopsy provides pathological insights to dual diseases. JACC CardioOncol 2021;3:330-4.
  26. Ahtarovski KA, Iversen KK, Christensen TE, et al. Takotsubo cardiomyopathy, a two-stage recovery of left ventricular systolic and diastolic function as determined by cardiac magnetic resonance imaging. Eur Heart J Cardiovasc Imaging 2014;15:855-62.
  27. Alashi A, Isaza N, Faulx J, et al. Characteristics and outcomes of patients with Takotsubo syndrome: incremental prognostic value of baseline left ventricular systolic function. J Am Heart Assoc 2020;9:e016537.
  28. Citro R, Radano I, Parodi G, et al. Long-term outcome in patients with Takotsubo syndrome presenting with severely reduced left ventricular ejection fraction. Eur J Heart Fail 2019;21:781-9.
  29. Murugiah K, Wang Y, Desai NR, et al. Trends in short- and long-term outcomes for Takotsubo cardiomyopathy among medicare fee-for-service beneficiaries, 2007 to 2012. JACC Heart Fail 2016;4:197-205.
  30. Butt JH, Bang LE, Rorth R, et al. Long-term risk of death and hospitalization in patients with heart failure and Takotsubo syndrome: insights from a nationwide cohort. J Card Fail 2022;28:1534-44.