Impact of residual inflammation on myocardial recovery and cardiovascular outcome in Takotsubo patients
© 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology..
AIMS: Recent insights have emphasized the importance of myocardial and systemic inflammation in Takotsubo syndrome (TTS). In a large registry of unselected patients, we sought to evaluate whether residual high inflammatory response (RHIR) could impact cardiovascular outcome after TTS.
METHODS AND RESULTS: Patients with TTS were retrospectively included between 2008 and 2018 in three general hospitals. Three hundred eighty-five patients with TTS were split into three subgroups, according to tertiles of C-reactive protein (CRP) levels at discharge (CRP <5.2 mg/L, CRP range 5.2 to 19 mg/L, and CRP >19 mg/L). The primary endpoint was the impact of RHIR, defined as CRP >19 mg/L at discharge, on cardiac death or hospitalization for heart failure. Follow up was obtained in 382 patients (99%) after a median of 747 days. RHIR patients were more likely to have a history of cancer or a physical trigger. Left ventricular ejection fraction (LVEF) at admission and at discharge were comparable between groups. By contrast, RHIR was associated with lower LVEF at follow up (61.7% vs. 60.7% vs. 57.9%; P = 0.004) and increased cardiac late mortality (0% vs. 0% vs. 10%; P = 0.001). By multivariate Cox regression analysis, RHIR was an independent predictor of cardiac death or hospitalization for heart failure (hazard ratio: 1.87; 95% confidence interval: 1.08 to 3.25; P = 0.025).
CONCLUSIONS: Residual high inflammatory response was associated with impaired LVEF at follow up and was evidenced as an independent factor of cardiovascular events. All together, these findings underline RHIR patients as a high-risk subgroup, to target in future clinical trials with specific therapies to attenuate RHIR.
| Medienart: |
E-Artikel |
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| Erscheinungsjahr: |
2021 |
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| Erschienen: |
2021 |
| Enthalten in: |
Zur Gesamtaufnahme - volume:8 |
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| Enthalten in: |
ESC heart failure - 8(2021), 1 vom: 06. Feb., Seite 259-269 |
| Sprache: |
Englisch |
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| Beteiligte Personen: |
Lachmet-Thebaud, Lucie [VerfasserIn] |
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| Links: |
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| Anmerkungen: |
Date Completed 01.07.2021 Date Revised 05.10.2022 published: Print-Electronic Citation Status MEDLINE |
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| doi: |
10.1002/ehf2.12945 |
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| funding: |
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| Förderinstitution / Projekttitel: |
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| PPN (Katalog-ID): |
NLM317742213 |
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| 245 | 1 | 0 | |a Impact of residual inflammation on myocardial recovery and cardiovascular outcome in Takotsubo patients |
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| 500 | |a Date Revised 05.10.2022 | ||
| 500 | |a published: Print-Electronic | ||
| 500 | |a Citation Status MEDLINE | ||
| 520 | |a © 2020 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of the European Society of Cardiology. | ||
| 520 | |a AIMS: Recent insights have emphasized the importance of myocardial and systemic inflammation in Takotsubo syndrome (TTS). In a large registry of unselected patients, we sought to evaluate whether residual high inflammatory response (RHIR) could impact cardiovascular outcome after TTS | ||
| 520 | |a METHODS AND RESULTS: Patients with TTS were retrospectively included between 2008 and 2018 in three general hospitals. Three hundred eighty-five patients with TTS were split into three subgroups, according to tertiles of C-reactive protein (CRP) levels at discharge (CRP <5.2 mg/L, CRP range 5.2 to 19 mg/L, and CRP >19 mg/L). The primary endpoint was the impact of RHIR, defined as CRP >19 mg/L at discharge, on cardiac death or hospitalization for heart failure. Follow up was obtained in 382 patients (99%) after a median of 747 days. RHIR patients were more likely to have a history of cancer or a physical trigger. Left ventricular ejection fraction (LVEF) at admission and at discharge were comparable between groups. By contrast, RHIR was associated with lower LVEF at follow up (61.7% vs. 60.7% vs. 57.9%; P = 0.004) and increased cardiac late mortality (0% vs. 0% vs. 10%; P = 0.001). By multivariate Cox regression analysis, RHIR was an independent predictor of cardiac death or hospitalization for heart failure (hazard ratio: 1.87; 95% confidence interval: 1.08 to 3.25; P = 0.025) | ||
| 520 | |a CONCLUSIONS: Residual high inflammatory response was associated with impaired LVEF at follow up and was evidenced as an independent factor of cardiovascular events. All together, these findings underline RHIR patients as a high-risk subgroup, to target in future clinical trials with specific therapies to attenuate RHIR | ||
| 650 | 4 | |a Journal Article | |
| 650 | 4 | |a Research Support, Non-U.S. Gov't | |
| 650 | 4 | |a Late cardiac death | |
| 650 | 4 | |a Late cardiovascular outcome | |
| 650 | 4 | |a Predictive factor | |
| 650 | 4 | |a Residual high inflammatory response | |
| 650 | 4 | |a Systemic inflammatory response syndrome | |
| 650 | 4 | |a Takotsubo syndrome | |
| 700 | 1 | |a Marchandot, Benjamin |e verfasserin |4 aut | |
| 700 | 1 | |a Matsushita, Kensuke |e verfasserin |4 aut | |
| 700 | 1 | |a Sato, Chisato |e verfasserin |4 aut | |
| 700 | 1 | |a Dagrenat, Charlotte |e verfasserin |4 aut | |
| 700 | 1 | |a Greciano, Stephane |e verfasserin |4 aut | |
| 700 | 1 | |a De Poli, Fabien |e verfasserin |4 aut | |
| 700 | 1 | |a Leddet, Pierre |e verfasserin |4 aut | |
| 700 | 1 | |a Peillex, Marilou |e verfasserin |4 aut | |
| 700 | 1 | |a Hess, Sébastien |e verfasserin |4 aut | |
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| 700 | 1 | |a Jimenez, Charline |e verfasserin |4 aut | |
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| 700 | 1 | |a Ohlmann, Patrick |e verfasserin |4 aut | |
| 700 | 1 | |a Jesel, Laurence |e verfasserin |4 aut | |
| 700 | 1 | |a Morel, Olivier |e verfasserin |4 aut | |
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