title: Predictive Value of QRS Duration at Admission for In-Hospital Clinical Outcome of Takotsubo Cardiomyopathy.
abstract: Prolonged QRS duration (pQRSd) on electrocardiogram (ECG) is a strong predictor of poor outcome in heart failure, myocardial infarction, and myocarditis, but it is unclear whether pQRSd also predicts poor outcomes of takotsubo cardiomyopathy (TC).
  
  
  
  Between 1 January 2010 and 31 December 2012, we retrospectively enrolled 299 patients with TC (mean age, 73.5±11.7 years; 21.4% male) from the Tokyo CCU Network database, which consists of 71 cardiovascular centers in the metropolitan area. In-hospital clinical outcomes were compared between patients with pQRSd on admission ECG (QRS ≥120 ms; n=34) and those with normal QRS duration (<120 ms; n=265). The in-hospital mortality rate for pQRSd was significantly higher than that for normal QRS duration (23.5% vs. 3.8%, P<0.001). Similarly, prevalence of ventilator use (38.2% vs. 11.4%, P<0.001), ventricular tachycardia or fibrillation (14.7% vs. 1.5%, P<0.001), and circulatory failure requiring catecholamine or cardiopulmonary supportive devices (41.2% vs. 14.0%, P<0.001) was significantly higher in the pQRSd group. On multivariate logistic regression analysis, pQRSd was an independent predictor for both in-hospital mortality (OR, 5.06; 95% CI: 1.79-14.30, P=0.002) and cardiac death (OR, 7.34; 95% CI: 1.33-40.51, P=0.02).
  
  
  
  TC with pQRSd is associated with poor in-hospital clinical outcome. Aggressive intervention may be required to prevent severe complications in these patients.
authors.affiliation: Tokyo CCU Network Scientific Committee.
authors.forename: Tetsuo
authors.initials: T
authors.lastname: Yamaguchi
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Yoshikawa
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Isogai
authors.forename: Takamichi
authors.initials: T
authors.lastname: Miyamoto
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Maekawa
authors.forename: Tetsuro
authors.initials: T
authors.lastname: Ueda
authors.forename: Konomi
authors.initials: K
authors.lastname: Sakata
authors.forename: Tsutomu
authors.initials: T
authors.lastname: Murakami
authors.forename: Takeshi
authors.initials: T
authors.lastname: Yamamoto
authors.forename: Ken
authors.initials: K
authors.lastname: Nagao
authors.forename: Morimasa
authors.initials: M
authors.lastname: Takayama
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D011446:Prospective Studies; D054549:Takotsubo Cardiomyopathy / Q000401:mortality* / Q000503:physiopathology*