Clinical characteristics, ballooning pattern, and long-term prognosis of transient left ventricular ballooning syndrome.
OBJECTIVE
Although patients with transient left ventricular ballooning syndrome (TLVBS), also known as Takotsubo cardiomyopathy, improve rapidly and recover left ventricular systolic function, the long-term prognosis is not well-known. This study investigated the clinical features of TLVBS, and its in-hospital and long-term (in-hospital plus postdischarge) mortality.


RESULTS
We evaluated 87 patients diagnosed with TLVBS. The median follow-up was 42 months (interquartile range, 19 to 72 months). During follow-up, no recurrences were reported, but 20 (23%) patients died. Two nonsurvivors (2%) were suspected of dying from sudden cardiac death. The in-hospital total mortality rate was 9%, but the in-hospital cardiac mortality rate was 0%. Most deaths were associated with underlying noncardiac diseases. Baseline characteristics were mostly similar between survivors and nonsurvivors. However, nonsurvivors were older, and more likely to be smokers compared with survivors. Underlying noncardiac diseases were the only independent predictors of long-term mortality (hazard ratio, 3.954; 95% confidence interval, 1.369 to 11.422; P=.011). There were no significant differences in long-term mortality, according to the preceding stress events or ballooning patterns.


CONCLUSIONS
Although a substantial number of patients with TLVBS die, the long-term cardiac mortality is low. The severity of heart failure owing to TLVBS may influence in-hospital mortality, whereas underlying noncardiac diseases have a more significant correlation with the long-term prognosis than does TLVBS itself.
Song
Bong Gun
BG
Department of Medicine, Samsung Medical Center, Sungkyunkwan University School of Medicine, Gangnam-gu, Seoul, Republic of Korea.
Hahn
Joo-Yong
JY
Cho
Soo Jin
SJ
Park
Young Hwan
YH
Choi
Seung Min
SM
Park
Ji Han
JH
Choi
Seung-Hyuk
SH
Choi
Jin-Ho
JH
Park
Seung Woo
SW
Lee
Sang Hoon
SH
Gwon
Hyeon-Cheol
HC
D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D016001:Confidence Intervals; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D011379:Prognosis; D016016:Proportional Hazards Models; D056910:Republic of Korea; D012189:Retrospective Studies; D012307:Risk Factors; D012720:Severity of Illness Index; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis* / Q000401:mortality / Q000473:pathology; D013997:Time Factors