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Prevalence, management, and outcome of adverse rhythm disorders in takotsubo syndrome: insights from the international multicenter GEIST registry

  • Ibrahim El-BattrawyEmail author
  • Francesco Santoro
  • Thomas Stiermaier
  • Christian Möller
  • Francesca Guastafierro
  • Giuseppina Novo
  • Salvatore Novo
  • Andrea Santangelo
  • Enrica Mariano
  • Francesco Romeo
  • Fabiana Romeo
  • Holger Thiele
  • Federico Guerra
  • Alessandro Capucci
  • Irene Giannini
  • Pasquale Caldarola
  • Natale Daniele Brunetti
  • Ingo Eitel
  • Ibrahim Akin
Article

Abstract

One important complication related to takotsubo syndrome (TTS) is adverse rhythm disorders. Our study was conducted to determine the incidence and management of adverse rhythm disorders in TTS and its long-term prognostic impact. We analyzed 906 TTS patients from 9 European centers. Patients were divided into the adverse rhythm disorders group (encompassing ventricular tachycardia, ventricular fibrillation, torsade de pointes, and asystole or complete atrioventricular block) and non-adverse rhythm disorders group. In our study cohort, we identified 67 (7.4%) patients with presence of adverse rhythm disorders. TTS patients were followed up over a period of 2.8 years. In the adverse rhythm disorders group, 18% of patients presented adverse rhythm disorders before hospital admission. Asystole and/or AV block were significantly more presented before admission (13 patients versus 8 patients; p < 0.01), whereas ventricular tachyarrhythmias were more presented in-hospital (4 patients versus 42 patients; p < 0.01). Adverse rhythm disorders patients suffered more frequently from cardiogenic shock (31% versus 7.6%, p < 0.01) and in-hospital death (10.9% versus 3.6%; p < 0.01). Furthermore, the long-term survival was significantly impaired in adverse rhythm disorders patients as compared with non-adverse rhythm disorders patients; (log-rank p < 0.01). Using multivariate Cox regression analysis, cardiogenic shock (HR 2.86, 95% CI 1.1–6.9; p = 0.02) was identified as independent predictors of adverse rhythm disorders. The short- and long-term mortality rate of TTS patients presenting with adverse rhythm disorders was significantly higher than in TTS patients presenting without it. Therefore, TTS patients with adverse rhythm disorders should be carefully monitored during hospital stay and at long-term follow-up.

Keywords

Takotsubo syndrome Malignant arrhythmia Outcome Management Ventricular tachycardia ICD Torsade de pointes 

Notes

Compliance with ethical standards

The study was approved by the local ethics committees of the participating study centers.

Conflict of interest

The authors declare that they have no conflict of interest.

Supplementary material

10741_2019_9856_MOESM1_ESM.docx (22 kb)
ESM 1 (DOCX 21 kb)

References

  1. 1.
    Redfors B, Vedad R, Angeras O, Ramunddal T, Petursson P, Haraldsson I et al (2015) Mortality in takotsubo syndrome is similar to mortality in myocardial infarction - a report from the SWEDEHEART registry. Int J Cardiol 185:282–289CrossRefGoogle Scholar
  2. 2.
    Stiermaier T, Moeller C, Oehler K, Desch S, Graf T, Eitel C, Vonthein R, Schuler G, Thiele H, Eitel I (2016) Long-term excess mortality in takotsubo cardiomyopathy: predictors, causes and clinical consequences. Eur J Heart Fail 18:650–656CrossRefGoogle Scholar
  3. 3.
    Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M, Cammann VL, Sarcon A, Geyer V, Neumann CA, Seifert B, Hellermann J, Schwyzer M, Eisenhardt K, Jenewein J, Franke J, Katus HA, Burgdorf C, Schunkert H, Moeller C, Thiele H, Bauersachs J, Tschöpe C, Schultheiss HP, Laney CA, Rajan L, Michels G, Pfister R, Ukena C, Böhm M, Erbel R, Cuneo A, Kuck KH, Jacobshagen C, Hasenfuss G, Karakas M, Koenig W, Rottbauer W, Said SM, Braun-Dullaeus RC, Cuculi F, Banning A, Fischer TA, Vasankari T, Airaksinen KEJ, Fijalkowski M, Rynkiewicz A, Pawlak M, Opolski G, Dworakowski R, MacCarthy P, Kaiser C, Osswald S, Galiuto L, Crea F, Dichtl W, Franz WM, Empen K, Felix SB, Delmas C, Lairez O, Erne P, Bax JJ, Ford I, Ruschitzka F, Prasad A, Lüscher TF (2015) Clinical features and outcomes of takotsubo (stress) cardiomyopathy. N Engl J Med 373:929–938CrossRefGoogle Scholar
  4. 4.
    El-Battrawy I, Zhao Z, Lan H, Schunemann JD, Sattler K, Buljubasic F et al (2018) Estradiol protection against toxic effects of catecholamine on electrical properties in human-induced pluripotent stem cell derived cardiomyocytes. Int J Cardiol 254:195–202CrossRefGoogle Scholar
  5. 5.
    Willis BC, Salazar-Cantu A, Silva-Platas C, Fernandez-Sada E, Villegas CA, Rios-Argaiz E et al (2015) Impaired oxidative metabolism and calcium mishandling underlie cardiac dysfunction in a rat model of post-acute isoproterenol-induced cardiomyopathy. Am J Physiol Heart Circ Physiol 308:H467–H477CrossRefGoogle Scholar
  6. 6.
    Madias C, Fitzgibbons TP, Alsheikh-Ali AA, Bouchard JL, Kalsmith B, Garlitski AC, Tighe DA, Estes NAM III, Aurigemma GP, Link MS (2011) Acquired long QT syndrome from stress cardiomyopathy is associated with ventricular arrhythmias and torsades de pointes. Heart Rhythm 8:555–561CrossRefGoogle Scholar
  7. 7.
    El-Battrawy I, Lang S, Ansari U, Tulumen E, Schramm K, Fastner C et al (2017) Prevalence of malignant arrhythmia and sudden cardiac death in takotsubo syndrome and its management. Europace.Google Scholar
  8. 8.
    Stiermaier T, Eitel C, Denef S, Desch S, Schuler G, Thiele H, Eitel I (2015) Prevalence and clinical significance of life-threatening arrhythmias in takotsubo cardiomyopathy. J Am Coll Cardiol 65:2148–2150CrossRefGoogle Scholar
  9. 9.
    Santoro F, Stiermaier T, Tarantino N, De Gennaro L, Moeller C, Guastafierro F et al (2017) Left ventricular thrombi in takotsubo syndrome: incidence, predictors, and management: results from the GEIST (German Italian Stress Cardiomyopathy) registry. J Am Heart Assoc 6Google Scholar
  10. 10.
    Santoro F, Stiermaier T, Tarantino N, Guastafierro F, Graf T, Moller C et al (2018) Impact of persistent ST elevation on outcome in patients with Takotsubo syndrome. Results from the GErman Italian STress Cardiomyopathy (GEIST) registry. Int J Cardiol 255:140–144CrossRefGoogle Scholar
  11. 11.
    Stiermaier T, Santoro F, El-Battrawy I, Moller C, Graf T, Novo G et al (2018) Prevalence and prognostic impact of diabetes in takotsubo syndrome: insights from the international, multicenter GEIST registry. Diabetes Care 41:1084–1088CrossRefGoogle Scholar
  12. 12.
    Lyon AR, Bossone E, Schneider B, Sechtem U, Citro R, Underwood SR, Sheppard MN, Figtree GA, Parodi G, Akashi YJ, Ruschitzka F, Filippatos G, Mebazaa A, Omerovic E (2016) Current state of knowledge on takotsubo syndrome: a position statement from the taskforce on takotsubo syndrome of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 18:8–27CrossRefGoogle Scholar
  13. 13.
    Eitel I, von Knobelsdorff-Brenkenhoff F, Bernhardt P, Carbone I, Muellerleile K, Aldrovandi A, Francone M, Desch S, Gutberlet M, Strohm O, Schuler G, Schulz-Menger J, Thiele H, Friedrich MG (2011) Clinical characteristics and cardiovascular magnetic resonance findings in stress (takotsubo) cardiomyopathy. JAMA. 306:277–286PubMedGoogle Scholar
  14. 14.
    Lee PH, Song JK, Sun BJ, Choi HO, Seo JS, Na JO, Kim DH, Song JM, Kang DH, Kim JJ, Park SW (2010) Outcomes of patients with stress-induced cardiomyopathy diagnosed by echocardiography in a tertiary referral hospital. J Am Soc Echocardiogr 23:766–771CrossRefGoogle Scholar
  15. 15.
    Perazzolo Marra M, Zorzi A, Corbetti F, De Lazzari M, Migliore F, Tona F et al (2013) Apicobasal gradient of left ventricular myocardial edema underlies transient T-wave inversion and QT interval prolongation (Wellens’ ECG pattern) in tako-tsubo cardiomyopathy. Heart Rhythm 10:70–77CrossRefGoogle Scholar
  16. 16.
    Santoro F, Brunetti ND, Tarantino N, Romero J, Guastafierro F, Ferraretti A, di Martino LFM, Ieva R, Pellegrino PL, di Biase M, di Biase L (2017) Dynamic changes of QTc interval and prognostic significance in takotsubo (stress) cardiomyopathy. Clin Cardiol 40:1116–1122CrossRefGoogle Scholar
  17. 17.
    Santoro F, Ieva R, Ferraretti A, Fanelli M, Musaico F, Tarantino N, Martino LD, Gennaro LD, Caldarola P, Biase MD, Brunetti ND (2016) Hemodynamic effects, safety, and feasibility of intravenous esmolol infusion during takotsubo cardiomyopathy with left ventricular outflow tract obstruction: results from a multicenter registry. Cardiovasc Ther 34:161–166CrossRefGoogle Scholar
  18. 18.
    Stiermaier T, Rommel KP, Eitel C, Moller C, Graf T, Desch S et al (2016) Management of arrhythmias in patients with takotsubo cardiomyopathy: is the implantation of permanent devices necessary? Heart Rhythm 13:1979–1986CrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2019

Authors and Affiliations

  • Ibrahim El-Battrawy
    • 1
    • 2
    Email author
  • Francesco Santoro
    • 3
  • Thomas Stiermaier
    • 4
  • Christian Möller
    • 4
  • Francesca Guastafierro
    • 3
  • Giuseppina Novo
    • 5
  • Salvatore Novo
    • 5
  • Andrea Santangelo
    • 5
  • Enrica Mariano
    • 6
  • Francesco Romeo
    • 6
  • Fabiana Romeo
    • 6
  • Holger Thiele
    • 7
  • Federico Guerra
    • 8
  • Alessandro Capucci
    • 8
  • Irene Giannini
    • 8
  • Pasquale Caldarola
    • 9
  • Natale Daniele Brunetti
    • 3
  • Ingo Eitel
    • 4
  • Ibrahim Akin
    • 1
    • 2
  1. 1.First Department of Medicine, Faculty of MedicineUniversity Medical Centre Mannheim (UMM) University of HeidelbergMannheimGermany
  2. 2.DZHK (German Center for Cardiovascular Research)MannheimGermany
  3. 3.Department of Medical and Surgery SciencesUniversity of FoggiaFoggiaItaly
  4. 4.Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK)University Heart Center LübeckLübeckGermany
  5. 5.Biomedical Department of Internal Medicine and Medical Specialties, Cardiology UnitUniversity of PalermoPalermoItaly
  6. 6.Division of CardiologyUniversity of Rome Tor VergataRomeItaly
  7. 7.Department of Internal Medicine/CardiologyHeart Center Leipzig - University HospitalLeipzigGermany
  8. 8.Cardiology and Arrhythmology Clinic, University Hospital “Umberto I–Lancisi–Salesi”Marche Polytechnic UniversityAnconaItaly
  9. 9.Department of CardiologySan Paolo HospitalBariItaly

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