Outcomes in Takotsubo Syndrome Following Left Ventricular Ejection Fraction Improvement

Abstract

Takotsubo syndrome (TTS) is evaluated by monitoring of left ventricular (LV) ejection fraction (LVEF); however, there are limited data to correlate echocardiographic findings with long-term outcomes. This study assessed clinical outcomes in patients with TTS and their association with echocardiographic parameters. Echocardiographic parameters at the time of diagnosis and on first follow-up were collected for 115 consecutive patients (58.5 ± 15.2 years, 74.8% women) diagnosed with TTS. The primary clinical end points were all-cause mortality and time to first readmission. Cox proportional hazard analysis was used to assess the association between echocardiographic parameters and clinical end points. Mean baseline LVEF and global longitudinal strain (GLS) were 37.1 ± 10.7% and -8.5 ± 3.4%, respectively. On follow-up echocardiogram at median of 14 days, LVEF and GLS improved to 58.7 ± 9.3% and -14.2 ± 4.0%, respectively. Most patients (83%) experienced normalization of LVEF (>50%), whereas only 20% had normalization of LV-GLS (<-18%). A total of 99 patients had clinical follow-up after the second echocardiogram with a median follow-up time of 1.3 years. Estimated Kaplan-Meier survival at 2 years was 80% (95% confidence interval 69% to 88%), and median time to readmission was 226 days. There was no significant association between any of the echocardiographic parameters (including LV end-diastolic diameter and baseline, follow-up, and differential LVEF and GLS) and our clinical end points. Zero deaths and only 10.4% of first readmissions were from cardiovascular causes. This suggests that although cardiology follow-up with repeat imaging is important after TTS, additional follow-up with noncardiology specialists is essential to improve outcomes.