title: Echocardiographic correlates of acute heart failure, cardiogenic shock, and in-hospital mortality in tako-tsubo cardiomyopathy.
abstract: OBJECTIVE
  The purpose of this study was to determine clinical and echocardiographic correlates of acute heart failure, cardiogenic shock and in-hospital mortality in a large cohort of tako-tsubo cardiomyopathy (TTC) patients.
  
  
  BACKGROUND
  Despite good long-term prognosis, life-threatening complications due to hemodynamic instability can occur early in TTC patients.
  
  
  METHODS
  The study population consisted of 227 patients (66.2 ± 12.2 years of age; females, 90.3%) enrolled in the Tako-tsubo Italian Network, undergoing transthoracic two-dimensional echocardiography on admission and at short-term follow-up (4.3 [4 to 6] weeks). Patients were divided into two groups according to the presence or absence of major adverse events, a composite of acute heart failure, cardiogenic shock, and in-hospital mortality.
  
  
  RESULTS
  Major adverse events occurred in 59 patients (25.9%). The variables for elderly patients ≥ 75 years of age (42.4% vs. 23.8%; p = 0.011): left ventricular (LV) ejection fraction (35.1 ± 5.9% vs. 38.4 ± 4.6%, p < 0.001), wall motion score index (1.9 ± 0.2 vs. 1.7 ± 0.2, p < 0.001), E/e' ratio (13.5 ± 4.3 vs. 9.9 ± 3.3 [where E/e' is ratio of mitral E peak velocity and averaged e' velocity], p < 0.001), LV outflow tract obstruction (23.7 vs. 8.9%, p = 0.006), pulmonary artery systolic pressure (47.4 ± 12.3 mm Hg vs. 38.0 ± 9.2 mm Hg; p < 0.001), right ventricular involvement (28.8 vs. 9.5%; p < 0.001), and reversible moderate-to-severe mitral regurgitation (49.1 vs. 11.9%; p < 0.001), were significantly different between groups and were associated with adverse events. At multivariate analysis, LV ejection fraction (HR: 0.92; 95% CI: 0.89 to 0.95; p < 0.001), E/e' ratio (HR: 1.13; 95% CI: 1.02 to 1.24; p = 0.011), reversible moderate to severe mitral regurgitation (HR: 3.25; 95% CI: 1.16 to 9.10; p = 0.025), and age ≥ 75 years (HR: 2.81; 95% CI: 1.05 to 7.52; p = 0.039) were independent correlates of major adverse events.
  
  
  CONCLUSIONS
  Echocardiographic parameters provide additional information compared to other variables routinely used in clinical practice to identify patients at higher risk of hemodynamic deterioration and poor in-hospital outcome, allowing prompt institution of appropriate pharmacological treatment and adequate mechanical support.
authors.affiliation: Department of Heart Sciences, Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy; Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy. Electronic address: rodolfocitro@gmail.com.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Citro
authors.affiliation: Department of Cardiology, Dell'Angelo Hospital, Mestre, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Rigo
authors.affiliation: Department of Cardiology, Second University of Naples, Naples, Italy.
authors.forename: Antonello
authors.initials: A
authors.lastname: D'Andrea
authors.affiliation: Department of Cardiology, Fatebenefratelli Hospital, Benevento, Italy.
authors.forename: Quirino
authors.initials: Q
authors.lastname: Ciampi
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Parodi
authors.affiliation: Division of Cardiology, Civic Hospital, Villa d'Agri, Potenza, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Provenza
authors.affiliation: Department of Clinical Medicine, Cardiovascular Sciences and Immunology, Federico II, University of Naples, Naples, Italy.
authors.forename: Raffaele
authors.initials: R
authors.lastname: Piccolo
authors.affiliation: Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Mirra
authors.affiliation: Division of Cardiology, University of Messina, Messina, Italy.
authors.forename: Concetta
authors.initials: C
authors.lastname: Zito
authors.affiliation: Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
authors.forename: Roberta
authors.initials: R
authors.lastname: Giudice
authors.affiliation: Division of Cardiology, S. Maria Hospital, Terni, Italy.
authors.forename: Marco Mariano
authors.initials: MM
authors.lastname: Patella
authors.affiliation: Division of Cardiology, S. Maria degli Angeli Hospital, Pordenone, Italy.
authors.forename: Francesco
authors.initials: F
authors.lastname: Antonini-Canterin
authors.affiliation: Heart Department, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.affiliation: Department of Medicine and Surgery, University of Salerno, Salerno, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Piscione
authors.affiliation: Department of Heart Sciences, Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy.
authors.forename: Jorge
authors.initials: J
authors.lastname: Salerno-Uriarte
mesh_terms: D000208:Acute Disease; D000368:Aged; D016009:Chi-Square Distribution; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D006439:Hemodynamics; D017052:Hospital Mortality; D006801:Humans; D007558:Italy / Q000453:epidemiology; D016015:Logistic Models; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000000981:diagnostic imaging / Q000401:mortality; D015999:Multivariate Analysis; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012307:Risk Factors; D012770:Shock, Cardiogenic / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D013318:Stroke Volume; D054549:Takotsubo Cardiomyopathy / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D013997:Time Factors; D014463:Ultrasonography; D016277:Ventricular Function, Left
keywords: acute heart failure; cardiogenic shock; echocardiography; stress cardiomyopathy; tako-tsubo cardiomyopathy