Clinical outcomes associated with catecholamine use in patients diagnosed with Takotsubo cardiomyopathy

BMC Cardiovascular Disorders

Katherine Sattler¹  Ibrahim El-Battrawy¹  Christian Fastner¹  Uzair Ansari¹  Aydin Huseynov¹  Michael Behnes¹  Martin Borggrefe¹  Stefan Baumann¹  Erol Tülümen¹  Ibrahim Akin¹ 

[1] First Department of Medicine, University Medical Center Mannheim, University of Heidelberg;

关键词: Takotsubo cardiomyopathy;    Cardiogenic shock;    Heart failure;    Catecholamines;   

DOI  :  10.1186/s12872-018-0784-6

来源: DOAJ

【 摘 要 】

Abstract Background Recent hypotheses have suggested the pathophysiological role of catecholamines in the evolution of the Takotsubo syndrome (TTS). The extent of cardiac and circulatory compromise dictates the use of some form of supportive therapy. This study was designed to investigate the clinical outcomes associated with catecholamine use in TTS patients. Methods Our institutional database constituted a collective of 114 patients diagnosed with TTS between 2003 and 2015. The study-patients were subsequently classified into two groups based on the need for catecholamine support during hospital stay (catecholamine group n = 93; 81%, non-catecholamine group = 21; 19%). The primary end-point of our study was all-cause mortality. Results Patients receiving catecholamine support showed higher grades of circulatory and cardiac compromise (left ventricular ejection fraction (LVEF) 39.6% vs. 32.7%, p-value < 0.01) and the course of disease was often complicated by the occurrence of different TTS-associated complications. The in-hospital mortality (3.2% vs. 28.5%, p < 0.01), 30-day mortality (17.2% vs. 51.4%, p < 0.01) as well as long-term mortality (38.7% vs. 80.9%, p < 0.01) was significantly higher in the group of patients receiving catecholamine support. A multivariate Cox regression analysis attributed EF ≤ 35% (HR 3.6, 95% CI 1.6–8.1; p < 0.01) and use of positive inotropic agents (HR 2.2, 95% CI 1.0–4.8; p 0.04) as independent predictors of the adverse outcome. Conclusion Rates of in-hospital events and short- as well as long-term mortality were significantly higher in TTS patients receiving catecholamine support as compared to the other study-patients. These results need further evaluation in pre-clinical and clinical trials to determine if external catecholamines contribute to an adverse clinical outcome already compromised by the initial insult.

【 授权许可】

Unknown