title: Clinical profile and in-hospital outcome of Caucasian patients with takotsubo syndrome and right ventricular involvement.
abstract: OBJECTIVE
  To determine the prevalence, clinical characteristics, in-hospital course and determinants of major adverse events in a cohort of Caucasian patients with Takotsubo syndrome (TTS) and right ventricular involvement (RVi), regardless of left ventricular variant forms.
  
  
  RESULTS
  The study population consisted of 424 patients (mean age 69.1±11.5years; female 92.2%) with a diagnosis of TTS divided into two groups according to the presence or absence of RVi. RVi patients (n=57; 13.4%) showed a higher prevalence of comorbidities, especially respiratory diseases (p=0.011), and a higher Charlson comorbidity index (CCI; p=0.006) than non-RVi patients. In-hospital major adverse events (acute heart failure, cardiogenic shock and death) occurred more frequently in RVi patients (p<0.001). Heart rate and CCI, along with the echocardiographic parameters of wall motion score index, E/e' ratio, tricuspid annular plane systolic excursion (TAPSE) and systolic pulmonary artery pressure (sPAP) were associated with adverse in-hospital outcome. At multivariate analysis, CCI (HR: 1.871; 95% CI: 1.202-2.912; p=0.006), sPAP (HR: 1.059; 95% CI: 1.016-1.104; p=0.007) and TAPSE (HR: 0.728; 95% CI: 0.619-0.855; p<0.001) were independent correlates of the composite outcome in patients with RVi.
  
  
  CONCLUSIONS
  Patients with RVi are characterized by distinct clinical profile and should undergo closely clinical and echocardiographic monitoring. The presence of echocardiographic signs of right ventricular failure along with substantial comorbidities burden identify a cohort at higher risk of in-hospital major adverse cardiovascular events.
authors.affiliation: Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy; Department of Heart Sciences, Circolo Hospital and Macchi Foundation, University of Insubria, Varese, Italy. Electronic address: rodolfocitro@gmail.com.
authors.forename: Rodolfo
authors.initials: R
authors.lastname: Citro
authors.affiliation: Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
authors.forename: Eduardo
authors.initials: E
authors.lastname: Bossone
authors.affiliation: Division of Cardiology, Careggi Hospital, Florence, Italy.
authors.forename: Guido
authors.initials: G
authors.lastname: Parodi
authors.affiliation: Division of Cardiology, University of Messina, Messina, Italy.
authors.forename: Scipione
authors.initials: S
authors.lastname: Carerj
authors.affiliation: Division of Cardiology, Ospedale Fatebenefratelli, Benevento, Italy.
authors.forename: Quirino
authors.initials: Q
authors.lastname: Ciampi
authors.affiliation: Division of Cardiology, San Francesco d'Assisi, Oliveto Citra, Salerno, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Provenza
authors.affiliation: Division of Cardiology, University of Messina, Messina, Italy.
authors.forename: Concetta
authors.initials: C
authors.lastname: Zito
authors.affiliation: Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
authors.forename: Costantina
authors.initials: C
authors.lastname: Prota
authors.affiliation: Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
authors.forename: Angelo
authors.initials: A
authors.lastname: Silverio
authors.affiliation: Cardiology and Emergency Department, San Antonio Hospital, San Daniele del Friuli, Udine, Italy.
authors.forename: Olga
authors.initials: O
authors.lastname: Vriz
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, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
authors.forename: Gennaro
authors.initials: G
authors.lastname: Galasso
authors.affiliation: Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
authors.forename: Cesare
authors.initials: C
authors.lastname: Baldi
authors.affiliation: Department of Cardiology, Dell'Angelo Hospital, Mestre, Italy.
authors.forename: Fausto
authors.initials: F
authors.lastname: Rigo
authors.affiliation: Division of Cardiology, Ospedale Guglielmo da Saliceto, Piacenza, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Piepoli
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
authors.affiliation: Department of Cardiology, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
authors.forename: Federico
authors.initials: F
authors.lastname: Piscione
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D004452:Echocardiography / Q000401:mortality / Q000639:trends; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D012189:Retrospective Studies; D054549:Takotsubo Cardiomyopathy / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D016896:Treatment Outcome; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000628:therapy; D044465:White People
keywords: Right ventricle; TAPSE; Takotsubo; sPAP