Elsevier

Heart & Lung

Volume 39, Issue 3, May–June 2010, Pages 188-195
Heart & Lung

Issues in Cardiovascular Nursing
Clinical characteristics, ballooning pattern, and long-term prognosis of transient left ventricular ballooning syndrome

https://doi.org/10.1016/j.hrtlng.2009.07.006Get rights and content

Objective

Although patients with transient left ventricular ballooning syndrome (TLVBS), also known as Takotsubo cardiomyopathy, improve rapidly and recover left ventricular systolic function, the long-term prognosis is not well-known. This study investigated the clinical features of TLVBS, and its in-hospital and long-term (in-hospital plus postdischarge) mortality.

Methods and Results

We evaluated 87 patients diagnosed with TLVBS. The median follow-up was 42 months (interquartile range, 19 to 72 months). During follow-up, no recurrences were reported, but 20 (23%) patients died. Two nonsurvivors (2%) were suspected of dying from sudden cardiac death. The in-hospital total mortality rate was 9%, but the in-hospital cardiac mortality rate was 0%. Most deaths were associated with underlying noncardiac diseases. Baseline characteristics were mostly similar between survivors and nonsurvivors. However, nonsurvivors were older, and more likely to be smokers compared with survivors. Underlying noncardiac diseases were the only independent predictors of long-term mortality (hazard ratio, 3.954; 95% confidence interval, 1.369 to 11.422; P = .011). There were no significant differences in long-term mortality, according to the preceding stress events or ballooning patterns.

Conclusions

Although a substantial number of patients with TLVBS die, the long-term cardiac mortality is low. The severity of heart failure owing to TLVBS may influence in-hospital mortality, whereas underlying noncardiac diseases have a more significant correlation with the long-term prognosis than does TLVBS itself.

Introduction

Transient left ventricular ballooning syndrome (TLVBS), also known as Takotsubo cardiomyopathy or stress cardiomyopathy, is characterized by an acute onset of left ventricular (LV) dysfunction, accompanied by chest symptoms, electrocardiogram changes, and elevated cardiac markers in the absence of angiographically significant coronary artery stenoses.1, 2, 3, 4 Clinical recovery in this syndrome was reported as excellent in most cases, when appropriate treatment was performed during the acute phase.5, 6, 7, 8 However, there are few data regarding the long-term prognosis of TLVBS. Moreover, it remains unknown whether or not the preceding stress types or the ballooning patterns affect the long-term prognosis. In this study, we report on the long-term prognosis of TLVBS, and investigate the predictors of long-term prognosis.

Section snippets

Study patients

From January 1997 to October 2007, 6241 consecutive patients with a diagnosis of an acute coronary syndrome, including ST-elevation and non-ST-elevation myocardial infarction, underwent cardiac catheterization at a tertiary-care center (a hospital with 1951 sickbeds, with approximately 6500 staff members, including over 1200 doctors and 2000 nurses). Of 6241 patients, 87 (1.4%) were diagnosed with TLVBS. The criteria for inclusion involved: 1) transient akinesia/dyskinesia beyond a single major

Clinical characteristics of nonsurvivors

The clinical characteristics of nonsurvivors are summarized in Table I. The median follow-up was 42 months (interquartile range, 19 to 72 months). The overall long-term mortality was 23% (20 patients). Noncardiac mortality comprised 21% (18 patients), and cardiac mortality comprised 2% (2 patients). In terms of long-term mortality, 8 patients died of malignancy, 4 of stroke, 3 of pneumonia, and 3 of sepsis. Two patients were thought to have died from sudden cardiac attacks. The overall

Discussion

The clinical outcomes of patients with TLVBS are be generally favorable.10, 11, 12, 13 However, a limited amount of literature exists regarding the long-term prognosis of TLVBS.14, 15, 16

To the best of our knowledge, ours is one of the largest studies investigating the prognosis of TLVBS in detail in the most long-term period.17, 18 In our study, the overall long-term mortality was substantial, but cardiac mortality was low. Underlying noncardiac diseases were the only independent predictors of

Conclusions

In this study, we investigated the long-term prognosis of TLVBS. The in-hospital mortality as well as long-term cardiac mortality of TLVBS seemed to be low. The most common causes of deaths were associated with underlying noncardiac diseases, and not with TLVBS itself.

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