SPC365

Takotsubo syndrome in the 21st century: a Portuguese picture from a tertiary center

Session: SESSÃO DE POSTERS 33 - DOENÇAS CARDIOVASCULARES - MINOCA E SÍNDROME DE TAKOTSUBO
Speaker: C. Santos-Jorge

Congress: CPC 2025
Topic: E. Coronary Artery Disease, Acute Coronary Syndromes, Acute Cardiac Care
Theme: 14. Acute Cardiac Care
Subtheme: 14.6 Acute Cardiac Care – Other
Session Type: Cartazes
FP Number: ---
Authors: C. Santos-Jorge; Márcia Presume; Rui Miguel Gomes; André Moniz Garcia; Ana Rita Bello; Rita Almeida Carvalho; Rita Barbosa Sousa; Débora da Silva Correia; João Presume; António Tralhão; Catarina Brízido; Marisa Trabulo

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><u>Background</u>: Takotsubo syndrome (TTS) is a cause of acute heart failure (AHF), and its presentation mimics an acute coronary syndrome. Despite its classical presentation as an acute transient left ventricular dysfunction preceded by a specific trigger, a variety of clinical courses and outcomes have been described. We aimed to characterize a contemporary cohort of patients with TTS.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><u>Methods:</u>&nbsp;</span></span></span><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">Retrospective analysis of patients diagnosed with TTS admitted to a tertiary care center between 2009-2024. Baseline characteristics, clinical presentation and in-hospital complications, serial cardiac imaging and short-term outcomes at first outpatient follow-up appointment were analyzed.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><u>Results:</u></span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">A total of 107 patients (72&plusmn;12 years, 86% women) were included. The most common presenting symptom was chest pain (66%; n=71), with an identified trigger in 50% of patients. A recurrent episode was present in 5 patients. ST-segment elevation was the most frequent finding on ECG (47%, n=40), accompanied by troponin (peak 719 ng/L [IQR 280-1478]) and NTproBNP (peak 5162 pg/ml [IQR 2399-11204]) elevation.</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">Regional wall motion abnormalities were identified by TTE (n=100) and/or ventriculography (n=48), with apical ballooning by TTE and ventriculography on 86% and 81% of patients, respectively. Left ventricular ejection fraction (LVEF) was preserved in around 1/3 of patients, mildly reduced in 1/3 and reduced in 1/3. Obstructive CAD was evaluated in 87% (n=93) and excluded in 88% (n=82) of patients; no percutaneous coronary intervention was performed. </span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">Most patients had an uncomplicated clinical course and LVEF improved significantly before discharge (figure 1). However, 15% of patients presented with AHF, including 6.5% in cardiogenic shock. Cardiac arrest occurred in 5.6%, and in-hospital mortality was 3.8% (n=4). LVEF &lt;50% at admission was a predictor of in-hospital complications (OR 0.20, 95%CI 0.06-0.73, p=0.014).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">At discharge, 69% of patients were on angiotensin converting enzyme inhibitors and 73% were on beta-blocker. The first follow-up appointment (median 3 months [IQR 1-4]) was attended by 67 patients, with no TTS recurrences or readmissions in this timeframe. LVEF was reassessed in 47 patients at follow-up, maintaining significant improvement (figure 1).</span></span></span></p>

<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000"><u>Conclusion:</u>&nbsp;</span></span></span><span style="font-size:medium"><span style="font-family:Aptos,sans-serif"><span style="color:#000000">TTS represents a relevant cause of cardiac hospitalization, and despite a benign course, some patients still have worse outcomes. Long-term follow-up with routine multimodality imaging might shed light on pathophysiology and predictors of worse outcomes.</span></span></span></p>