Echocardiographic correlates of major adverse cardiac events at 1 year in patients with apical ballooning takotsubo syndrome

Lauren A. Farina; Anjan Tibrewala; Zhiying Meng; Abigail S. Baldridge; Jay M. Voit; Sasan R. Raissi; Michelle Lu; Sadiya S. Khan; Benjamin H. Freed; Nausheen Akhter

doi:10.1111/echo.15524

Echocardiographic correlates of major adverse cardiac events at 1 year in patients with apical ballooning takotsubo syndrome

Lauren A. Farina^*, Anjan Tibrewala, Zhiying Meng, Abigail S. Baldridge, Jay M. Voit, Sasan R. Raissi, Michelle Lu, Sadiya S. Khan, Benjamin H. Freed, Nausheen Akhter

^*Corresponding author for this work

Medicine, Cardiology Division

Research output: Contribution to journal › Article › peer-review

2 Scopus citations

Abstract

Introduction: Takotsubo syndrome (TTS) is characterized by transient left ventricular dysfunction and associated with considerable morbidity and mortality. We sought to evaluate the association between change in cardiac mechanics after diagnosis of TTS with 1-year incidence of major adverse cardiovascular events (MACE). Methods: We retrospectively identified 85 patients with apical TTS based on ICD 9/10 codes and chart adjudication, who had a follow-up echocardiogram within 6 months of diagnosis. Echocardiograms were analyzed for left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), GLS ratio, global circumferential strain (GCS), and global radial strain (GRS). Multivariable logistic regression was performed to identify parameters associated with MACE (all-cause mortality, heart failure, stroke, and coronary artery disease [CAD] requiring percutaneous coronary intervention [PCI]) at 1 year. Event-free survival was assessed in patients with GLS (≤−18% vs. >18%) and LVEF (≥53% vs. <53%). Results: Within 1 year of diagnosis, MACE occurred in 15 (18%) patients. Between baseline and follow-up echocardiogram (median 15 [range 1–151] days), there were significant differences in change in LVEF and GLS in patients with versus without incident MACE. In multivariate analysis, change in LVEF (odds ratio [OR] =.93 [.87,.98], p =.013) and change in GLS (OR = 1.32 [1.04, 1.67], p =.022) were independently associated with MACE; however, the association with change in GLS was attenuated (odds ratio [OR] = 1.13 [.94, 1.36], p =.21) after adjustment for baseline and change in LVEF. Among patients with normalized LVEF at follow-up, there were five (14.7%) MACE; whereas, there were no events among patients with normalized GLS. Conclusions: In patients with apical TTS, recovery in GLS and LVEF at follow-up was associated with significantly lower MACE at 1 year. Normalization of GLS at follow-up was better able to discriminate event-free survival than normalization of LVEF.

Original language	English (US)
Pages (from-to)	86-95
Number of pages	10
Journal	Echocardiography
Volume	40
Issue number	2
DOIs	https://doi.org/10.1111/echo.15524
State	Published - Feb 2023

Funding

Research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Keywords

major adverse cardiac events
strain
takotsubo

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Radiology Nuclear Medicine and imaging

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10.1111/echo.15524

Cite this

@article{1843e4e9389a4ec08f1e51bb8f95be6a,

title = "Echocardiographic correlates of major adverse cardiac events at 1 year in patients with apical ballooning takotsubo syndrome",

abstract = "Introduction: Takotsubo syndrome (TTS) is characterized by transient left ventricular dysfunction and associated with considerable morbidity and mortality. We sought to evaluate the association between change in cardiac mechanics after diagnosis of TTS with 1-year incidence of major adverse cardiovascular events (MACE). Methods: We retrospectively identified 85 patients with apical TTS based on ICD 9/10 codes and chart adjudication, who had a follow-up echocardiogram within 6 months of diagnosis. Echocardiograms were analyzed for left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), GLS ratio, global circumferential strain (GCS), and global radial strain (GRS). Multivariable logistic regression was performed to identify parameters associated with MACE (all-cause mortality, heart failure, stroke, and coronary artery disease [CAD] requiring percutaneous coronary intervention [PCI]) at 1 year. Event-free survival was assessed in patients with GLS (≤−18% vs. >18%) and LVEF (≥53% vs. <53%). Results: Within 1 year of diagnosis, MACE occurred in 15 (18%) patients. Between baseline and follow-up echocardiogram (median 15 [range 1–151] days), there were significant differences in change in LVEF and GLS in patients with versus without incident MACE. In multivariate analysis, change in LVEF (odds ratio [OR] =.93 [.87,.98], p =.013) and change in GLS (OR = 1.32 [1.04, 1.67], p =.022) were independently associated with MACE; however, the association with change in GLS was attenuated (odds ratio [OR] = 1.13 [.94, 1.36], p =.21) after adjustment for baseline and change in LVEF. Among patients with normalized LVEF at follow-up, there were five (14.7%) MACE; whereas, there were no events among patients with normalized GLS. Conclusions: In patients with apical TTS, recovery in GLS and LVEF at follow-up was associated with significantly lower MACE at 1 year. Normalization of GLS at follow-up was better able to discriminate event-free survival than normalization of LVEF.",

keywords = "major adverse cardiac events, strain, takotsubo",

author = "Farina, {Lauren A.} and Anjan Tibrewala and Zhiying Meng and Baldridge, {Abigail S.} and Voit, {Jay M.} and Raissi, {Sasan R.} and Michelle Lu and Khan, {Sadiya S.} and Freed, {Benjamin H.} and Nausheen Akhter",

note = "Funding Information: Research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: {\textcopyright} 2023 Wiley Periodicals LLC.",

year = "2023",

month = feb,

doi = "10.1111/echo.15524",

language = "English (US)",

volume = "40",

pages = "86--95",

journal = "Echocardiography",

issn = "0742-2822",

publisher = "John Wiley and Sons Inc.",

number = "2",

}

TY - JOUR

T1 - Echocardiographic correlates of major adverse cardiac events at 1 year in patients with apical ballooning takotsubo syndrome

AU - Farina, Lauren A.

AU - Tibrewala, Anjan

AU - Meng, Zhiying

AU - Baldridge, Abigail S.

AU - Voit, Jay M.

AU - Raissi, Sasan R.

AU - Lu, Michelle

AU - Khan, Sadiya S.

AU - Freed, Benjamin H.

AU - Akhter, Nausheen

N1 - Funding Information: Research reported in this publication was supported, in part, by the National Institutes of Health's National Center for Advancing Translational Sciences, Grant Number UL1TR001422. The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health. Publisher Copyright: © 2023 Wiley Periodicals LLC.

PY - 2023/2

Y1 - 2023/2

N2 - Introduction: Takotsubo syndrome (TTS) is characterized by transient left ventricular dysfunction and associated with considerable morbidity and mortality. We sought to evaluate the association between change in cardiac mechanics after diagnosis of TTS with 1-year incidence of major adverse cardiovascular events (MACE). Methods: We retrospectively identified 85 patients with apical TTS based on ICD 9/10 codes and chart adjudication, who had a follow-up echocardiogram within 6 months of diagnosis. Echocardiograms were analyzed for left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), GLS ratio, global circumferential strain (GCS), and global radial strain (GRS). Multivariable logistic regression was performed to identify parameters associated with MACE (all-cause mortality, heart failure, stroke, and coronary artery disease [CAD] requiring percutaneous coronary intervention [PCI]) at 1 year. Event-free survival was assessed in patients with GLS (≤−18% vs. >18%) and LVEF (≥53% vs. <53%). Results: Within 1 year of diagnosis, MACE occurred in 15 (18%) patients. Between baseline and follow-up echocardiogram (median 15 [range 1–151] days), there were significant differences in change in LVEF and GLS in patients with versus without incident MACE. In multivariate analysis, change in LVEF (odds ratio [OR] =.93 [.87,.98], p =.013) and change in GLS (OR = 1.32 [1.04, 1.67], p =.022) were independently associated with MACE; however, the association with change in GLS was attenuated (odds ratio [OR] = 1.13 [.94, 1.36], p =.21) after adjustment for baseline and change in LVEF. Among patients with normalized LVEF at follow-up, there were five (14.7%) MACE; whereas, there were no events among patients with normalized GLS. Conclusions: In patients with apical TTS, recovery in GLS and LVEF at follow-up was associated with significantly lower MACE at 1 year. Normalization of GLS at follow-up was better able to discriminate event-free survival than normalization of LVEF.

AB - Introduction: Takotsubo syndrome (TTS) is characterized by transient left ventricular dysfunction and associated with considerable morbidity and mortality. We sought to evaluate the association between change in cardiac mechanics after diagnosis of TTS with 1-year incidence of major adverse cardiovascular events (MACE). Methods: We retrospectively identified 85 patients with apical TTS based on ICD 9/10 codes and chart adjudication, who had a follow-up echocardiogram within 6 months of diagnosis. Echocardiograms were analyzed for left ventricular ejection fraction (LVEF), global longitudinal strain (GLS), GLS ratio, global circumferential strain (GCS), and global radial strain (GRS). Multivariable logistic regression was performed to identify parameters associated with MACE (all-cause mortality, heart failure, stroke, and coronary artery disease [CAD] requiring percutaneous coronary intervention [PCI]) at 1 year. Event-free survival was assessed in patients with GLS (≤−18% vs. >18%) and LVEF (≥53% vs. <53%). Results: Within 1 year of diagnosis, MACE occurred in 15 (18%) patients. Between baseline and follow-up echocardiogram (median 15 [range 1–151] days), there were significant differences in change in LVEF and GLS in patients with versus without incident MACE. In multivariate analysis, change in LVEF (odds ratio [OR] =.93 [.87,.98], p =.013) and change in GLS (OR = 1.32 [1.04, 1.67], p =.022) were independently associated with MACE; however, the association with change in GLS was attenuated (odds ratio [OR] = 1.13 [.94, 1.36], p =.21) after adjustment for baseline and change in LVEF. Among patients with normalized LVEF at follow-up, there were five (14.7%) MACE; whereas, there were no events among patients with normalized GLS. Conclusions: In patients with apical TTS, recovery in GLS and LVEF at follow-up was associated with significantly lower MACE at 1 year. Normalization of GLS at follow-up was better able to discriminate event-free survival than normalization of LVEF.

KW - major adverse cardiac events

KW - strain

KW - takotsubo

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Echocardiographic correlates of major adverse cardiac events at 1 year in patients with apical ballooning takotsubo syndrome

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