Residual systemic inflammatory burden is a major determinant of myocardial recovery and late cardiovascular outcome in Takotsubo patients - 09/01/21
Résumé |
Background |
Recent insights have emphasized the importance of myocardial and systemic inflammation in Takotsubo syndrome (TTS).
Purpose |
In a large registry of unselected patients, we sought to evaluate whether residual high inflammatory response (RHIR) could impact cardiovascular outcome after TTS.
Methods |
Patients with TTS were retrospectively included between 2008 and 2018 in three general hospitals. 385 patients with TTS were split into three subgroups, according to tertiles of C-reactive protein (CRP) levels at discharge (CRP<5.2mg/l, CRP range 5.2 to 19mg/l, and CRP>19mg/l). The primary endpoint was the impact of RHIR, defined as CRP>19mg/l at discharge, on cardiac death or hospitalization for heart failure.
Results |
Follow-up was obtained in 382 patients (99%) after a median of 747 days. RHIR patients were more likely to have a history of cancer or a physical trigger. Left ventricular ejection fraction (LVEF) at admission and at discharge was comparable between groups. By contrast, RHIR was associated with lower LVEF at follow-up (61.7 vs. 60.7 vs. 57.9%; P=0.004) and increased cardiac late mortality (0% vs. 0% vs. 10%; P=0.001). By multivariate Cox regression analysis, RHIR was an independent predictor of cardiac death or hospitalization for heart failure (hazard ratio: 1.97; 95% confidence interval: 1.11 to 3.49; P=0.02).
Conclusions |
RHIR was associated with impaired LVEF recovery and was evidenced as an independent factor of cardiovascular events. All together these findings underline RHIR patients as a high-risk subgroup, to target in future clinical trials with specific therapies to attenuate RHIR.
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Vol 13 - N° 1
P. 152-153 - janvier 2021 Retour au numéroBienvenue sur EM-consulte, la référence des professionnels de santé.