RT Journal Article
T1 Short- and Long-Term Prognostic Relevance of Cardiogenic Shock in Takotsubo Syndrome: Results From the RETAKO Registry.
A1 Almendro-Delia, Manuel
A1 Núñez-Gil, Iván J
A1 Lobo, Manuel
A1 Andrés, Mireia
A1 Vedia, Oscar
A1 Sionis, Alessandro
A1 Martin-García, Ana
A1 Cruz Aguilera, María
A1 Pereyra, Eduardo
A1 Martín de Miguel, Irene
A1 Linares Vicente, José A
A1 Corbí-Pascual, Miguel
A1 Bosch, Xavier
A1 Fabregat Andrés, Oscar
A1 Sánchez Grande Flecha, Alejandro
A1 Pérez-Castellanos, Alberto
A1 Pais, Javier López
A1 De Mora Martín, Manuel
A1 Escudier Villa, Juan María
A1 Martín Asenjo, Roberto
A1 Guillen Marzo, Marta
A1 Rueda Sobella, Ferrán
A1 Aceña, Álvaro
A1 García Acuña, José María
A1 García-Rubira, Juan C
A1 RETAKO Investigators, 
K1 Takotsubo syndrome
K1 beta blockers
K1 cardiogenic shock
K1 stress
AB This study sought to describe the incidence, determinants, and prognostic impact of cardiogenic shock (CS) in takotsubo syndrome (TTS). TTS can be associated with severe hemodynamic instability. The prognostic implication of CS has not been well characterized in large studies of TTS. We analyzed patients with a definitive TTS diagnosis (modified Mayo criteria) who were recruited for the National RETAKO (Registry on Takotsubo Syndrome) trial from 2003 to 2016. Cox and competing risk regression models were used to identify factors associated with mortality and recurrences. A total of 711 patients were included, 81 (11.4%) of whom developed CS. Male sex, QTc interval prolongation, lower left ventricular ejection fraction at admission, physical triggers, and presence of "a significant" left intraventricular pressure gradient, were associated with CS (C index = 0.85). In-hospital complication rates, including mortality, were significantly higher in patients with CS. Over a median follow-up of 284 days (interquartile range: 94 to 929 days), CS was the strongest independent predictor of long-term, all-cause mortality (hazard ratio [HR]: 5.38; 95% confidence interval [CI]: 2.60 to 8.38); cardiovascular (CV) death (sub-HR: 4.29; 95% CI: 2.40 to 21.2), and non-CV death (sub-HR: 3.34; 95% CI: 1.70 to 6.53), whereas no significant difference in the recurrence rate was observed between groups (sub-HR: 0.76; 95% CI: 0.10 to 5.95). Among patients with CS, those who received beta-blockers at hospital discharge experienced lower 1-year mortality compared with those who did not receive a beta-blocker (HR: 0.52; 95% CI: 0.44 to 0.79; pinteraction = 0.043). CS is not uncommon and is associated with worse short- and long-term prognosis in TTS. CS complicating TTS may constitute a marker of underlying disease severity and could identify a masked heart failure phenotype with increased vulnerability to catecholamine-mediated myocardial stunning.
YR 2018
FD 2018-10-10
LK http://hdl.handle.net/10668/13076
UL http://hdl.handle.net/10668/13076
LA en
DS RISalud
RD Apr 7, 2025