Cardiology and Cardiovascular Surgery Division. Hospital Universitario Virgen Macarena, Seville, Spain.
Cardiology and Cardiovascular Surgery Division. Hospital Universitario Virgen Macarena, Seville, Spain.
J Am Coll Cardiol. 2024 Sep 24;84(13):1163-1174. doi: 10.1016/j.jacc.2024.05.075.
Takotsubo syndrome (TTS) is a form of transient left ventricular (LV) dysfunction that usually resolves within days to weeks.
We aimed to assess the predictors and prognostic impact of time-to-LV recovery after TTS.
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) vs 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.
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 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 HR: 1.31; 95% CI: 1.12-1.60), with the risk of death increasing by 8% for every additional 10-day delay in time-to-LV recovery (adjusted HR: 1.08; 95% CI: 1.04-1.13).
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.
Takotsubo 综合征（TTS）是一种短暂性左心室（LV）功能障碍，通常在数天至数周内恢复。
我们旨在评估 TTS 后 LV 恢复的时间预测因素和预后影响。
全面回顾了全国多中心 RETAKO（Takotsubo 综合征登记处）的前瞻性连续影像学数据，以评估 LV 恢复的时间。多变量逻辑回归用于评估与晚期（≥10 天）与早期（<10 天）恢复相关的因素。使用完全调整的 Cox 模型比较晚期和早期恢复组之间全因死亡率的长期风险，并使用包含恢复时间的灵活参数生存模型作为连续变量。
共纳入 1463 例患者（中位年龄 73 岁，13%为男性），373 例（25%）为晚期，1090 例（75%）为早期 LV 恢复。年龄较大、有神经障碍病史、旁观者冠心病、活动性癌症、物理触发因素、炎症生物标志物升高、心源性休克和入院时较低的 LV 射血分数是晚期恢复的独立预测因素。在 4 年随访时，与早期恢复相比，晚期恢复患者的死亡风险明显更高（16.0%比 8.6%，调整 HR：1.31；95%CI：1.12-1.60），LV 恢复时间每延迟 10 天，死亡风险增加 8%（调整 HR：1.08；95%CI：1.04-1.13）。
TTS 后 LV 功能的晚期恢复与短期和长期生存率降低相关。对于没有早期 LV 恢复的 TTS 患者，可能需要更密切的临床随访。
