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Identifying High-Risk Patients After Takotsubo Syndrome: Long-Term Prognostic Predictors
Session:
Sessão de Comunicações Orais 07 – Para além do evento agudo: preditores e desfechos após lesão miocárdica
Speaker:
Rodrigo Malveiro Afonso
Congress:
CPC 2026
Topic:
P. Other
Theme:
37. Miscellanea
Subtheme:
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Session Type:
Comunicações Orais
FP Number:
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Authors:
Rodrigo Afonso; Marta Vilela; Daniel Inácio Cazeiro; Diogo Ferreira; João Cravo; Sofia Esteves; Inês Araújo; João Fernandes Pedro; Catarina Sena Silva; Pedro Carrilho Ferreira; Fausto J. Pinto
Abstract
<p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Introduction:</strong> Takotsubo syndrome (TTS) is an acute and reversible form of heart failure, but patients remain at risk for late cardiovascular events. Our aim was to evaluate long-term outcomes after TTS and determine the predictors associated with adverse events.</span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Methods:</strong> We conducted a retrospective observational study including all patients diagnosed with TTS at a tertiary centre between June 2012 and December 2024. Clinical, laboratory, and echocardiographic data were collected. The primary endpoint was a composite of death from any cause and hospitalization for cardiovascular causes. Predictors of adverse events were evaluated using univariable and multivariable regression analyses.</span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Results:</strong> We included 124 patients (84.5% women) with a mean age of 72.9±12.9 years. Clinical baseline characteristics are in <u>table 1</u>. At admission, 89.5% of patients were in sinus rhythm, the mean QTc was 467.6±46.4 ms and 47.0% had ST elevation. Also, the most frequent TTS type was apical (86.3), the mean left ventricular ejection fraction (LVEF) was 40.4 ± 10.4% and almost all patients recovered LVEF at discharge (mean LVEF 50.5 ± 11.8%). </span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">During hospitalization, 58.9% received angiotensin converting enzyme inhibitors (ACEi) or angiotensin receptor blockers (ARB), 25.0% beta blockers (BB), 13.7% calcium channel blockers (CCB), 36.3% aspirin, 13.7% P2Y12 inhibitors and 18.5% statins. At discharge, ACEi/ARB were prescribed in 83.9%, BB in 65.9%, CCB in 12.9%, aspirin in 45.2%, and statins in 70.2% After a mean follow-up of 3 years, the primary composite endpoint occurred in 25.8% (32 events: 10 hospitalizations for cardiovascular cause and 22 deaths). </span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif">In univariate analysis (non-parametric), lower haemoglobin at discharge (12.7 vs 11.1), lower peak C reactive protein (2.76 vs 6.5), lower discharge creatinine (0.84 vs 1.22), lower discharge urea (43 vs 55) and lower peak NT-proBNP (4187 vs 15294) were associated with fewer long-term events (p < 0.05 for all). No continuous variable was normally distributed. Among categorical variables, BB at discharge reduced risk (HR 0.369, 95%CI 0.146–0.931; p=0.031). In multivariate analysis (adjusted for age, sex, NYHA and admission LVEF), BB therapy remained protective (HR 0.273, 95%CI 0.098–0.763; p=0.013)- <u>graph 1.</u> Discharge urea was an independent predictor (HR 1.026, 95%CI 1.007–1.045; p=0.006). However, the number of events was low, so overfitting cannot be excluded.</span></span></p> <p><span style="font-size:12pt"><span style="font-family:"Times New Roman",serif"><strong>Conclusion:</strong> In this cohort of TTS patients, discharge beta-blockers reduced 3-year risk of death or CV hospitalization, while higher discharge urea predicted worse outcomes. Results suggest optimizing therapy and monitoring renal function.</span></span></p> <p> </p>
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