Admission heart rate and in-hospital course of patients with Takotsubo syndrome

Luca Arcari, Luca Rosario Limite, Luca Cacciotti, Matteo Sclafani, Domitilla Russo, Ilaria Passaseo, Giuseppe Marazzi, Gerardo Ansalone, Massimo Volpe, Camillo Autore, Maria Beatrice Musumeci

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Abstract

Background: In-hospital course of patients with Takotsubo syndrome (TS) is quite heterogeneous and life-threatening complications are not uncommon in the acute phase. The role of heart rate (HR) as a predictor of prognosis has not been sufficiently investigated in this setting. The study aims to assess the impact of HR at presentation on in-hospital course of patients with TS. Methods: The study population included 221 patients with TS enrolled in a multicentric registry. HR at admission was evaluated on the first electrocardiogram. According to tertile distribution of HR at presentation, 3 groups were identified: Group A (HR ≤ 76 beats per minute (bpm), n = 76), Group B (HR 77–95 bpm, n = 74) and Group C (HR > 95 bpm, n = 71). Acute in-hospital complications were defined as occurrence of severe pump failure and major arrhythmias. Results: 32 (14.4%) patients experienced complicated in-hospital course. HR on admission was significantly higher (108 bpm vs. 85 bpm; p < 0.001) and ejection fraction (EF) lower (35% vs. 40%; p = 0.009) in patients with complications than in those without. Patients in Group C experienced a 5-fold higher rate of complications compared to group A and B. After multivariate analysis, higher HR (odds ratio 1.34 per 10 bpm increase, 95% confidence interval (CI) 1.12–1.59; p = 0.001) and lower EF (odds ratio 1.24 per 5% decrease, 95% CI 1.01–1.54; p = 0.049) remained independently associated with a worse outcome. Conclusion: In a large population with TS, high HR on admission independently predicted complicated in-hospital course.

Original languageEnglish
Pages (from-to)15-21
Number of pages7
JournalInternational Journal of Cardiology
Volume273
DOIs
Publication statusPublished - Dec 15 2018

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Takotsubo Cardiomyopathy
Heart Rate
Odds Ratio
Confidence Intervals
Population
Registries
Cardiac Arrhythmias
Electrocardiography
Multivariate Analysis

Keywords

  • Acute pulmonary oedema
  • Heart rate
  • Prognosis
  • Shock
  • Takotsubo syndrome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Arcari, L., Limite, L. R., Cacciotti, L., Sclafani, M., Russo, D., Passaseo, I., ... Musumeci, M. B. (2018). Admission heart rate and in-hospital course of patients with Takotsubo syndrome. International Journal of Cardiology, 273, 15-21. https://doi.org/10.1016/j.ijcard.2018.07.145

Admission heart rate and in-hospital course of patients with Takotsubo syndrome. / Arcari, Luca; Limite, Luca Rosario; Cacciotti, Luca; Sclafani, Matteo; Russo, Domitilla; Passaseo, Ilaria; Marazzi, Giuseppe; Ansalone, Gerardo; Volpe, Massimo; Autore, Camillo; Musumeci, Maria Beatrice.

In: International Journal of Cardiology, Vol. 273, 15.12.2018, p. 15-21.

Research output: Contribution to journalArticle

Arcari, L, Limite, LR, Cacciotti, L, Sclafani, M, Russo, D, Passaseo, I, Marazzi, G, Ansalone, G, Volpe, M, Autore, C & Musumeci, MB 2018, 'Admission heart rate and in-hospital course of patients with Takotsubo syndrome', International Journal of Cardiology, vol. 273, pp. 15-21. https://doi.org/10.1016/j.ijcard.2018.07.145
Arcari, Luca ; Limite, Luca Rosario ; Cacciotti, Luca ; Sclafani, Matteo ; Russo, Domitilla ; Passaseo, Ilaria ; Marazzi, Giuseppe ; Ansalone, Gerardo ; Volpe, Massimo ; Autore, Camillo ; Musumeci, Maria Beatrice. / Admission heart rate and in-hospital course of patients with Takotsubo syndrome. In: International Journal of Cardiology. 2018 ; Vol. 273. pp. 15-21.
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title = "Admission heart rate and in-hospital course of patients with Takotsubo syndrome",
abstract = "Background: In-hospital course of patients with Takotsubo syndrome (TS) is quite heterogeneous and life-threatening complications are not uncommon in the acute phase. The role of heart rate (HR) as a predictor of prognosis has not been sufficiently investigated in this setting. The study aims to assess the impact of HR at presentation on in-hospital course of patients with TS. Methods: The study population included 221 patients with TS enrolled in a multicentric registry. HR at admission was evaluated on the first electrocardiogram. According to tertile distribution of HR at presentation, 3 groups were identified: Group A (HR ≤ 76 beats per minute (bpm), n = 76), Group B (HR 77–95 bpm, n = 74) and Group C (HR > 95 bpm, n = 71). Acute in-hospital complications were defined as occurrence of severe pump failure and major arrhythmias. Results: 32 (14.4{\%}) patients experienced complicated in-hospital course. HR on admission was significantly higher (108 bpm vs. 85 bpm; p < 0.001) and ejection fraction (EF) lower (35{\%} vs. 40{\%}; p = 0.009) in patients with complications than in those without. Patients in Group C experienced a 5-fold higher rate of complications compared to group A and B. After multivariate analysis, higher HR (odds ratio 1.34 per 10 bpm increase, 95{\%} confidence interval (CI) 1.12–1.59; p = 0.001) and lower EF (odds ratio 1.24 per 5{\%} decrease, 95{\%} CI 1.01–1.54; p = 0.049) remained independently associated with a worse outcome. Conclusion: In a large population with TS, high HR on admission independently predicted complicated in-hospital course.",
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AU - Arcari, Luca

AU - Limite, Luca Rosario

AU - Cacciotti, Luca

AU - Sclafani, Matteo

AU - Russo, Domitilla

AU - Passaseo, Ilaria

AU - Marazzi, Giuseppe

AU - Ansalone, Gerardo

AU - Volpe, Massimo

AU - Autore, Camillo

AU - Musumeci, Maria Beatrice

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N2 - Background: In-hospital course of patients with Takotsubo syndrome (TS) is quite heterogeneous and life-threatening complications are not uncommon in the acute phase. The role of heart rate (HR) as a predictor of prognosis has not been sufficiently investigated in this setting. The study aims to assess the impact of HR at presentation on in-hospital course of patients with TS. Methods: The study population included 221 patients with TS enrolled in a multicentric registry. HR at admission was evaluated on the first electrocardiogram. According to tertile distribution of HR at presentation, 3 groups were identified: Group A (HR ≤ 76 beats per minute (bpm), n = 76), Group B (HR 77–95 bpm, n = 74) and Group C (HR > 95 bpm, n = 71). Acute in-hospital complications were defined as occurrence of severe pump failure and major arrhythmias. Results: 32 (14.4%) patients experienced complicated in-hospital course. HR on admission was significantly higher (108 bpm vs. 85 bpm; p < 0.001) and ejection fraction (EF) lower (35% vs. 40%; p = 0.009) in patients with complications than in those without. Patients in Group C experienced a 5-fold higher rate of complications compared to group A and B. After multivariate analysis, higher HR (odds ratio 1.34 per 10 bpm increase, 95% confidence interval (CI) 1.12–1.59; p = 0.001) and lower EF (odds ratio 1.24 per 5% decrease, 95% CI 1.01–1.54; p = 0.049) remained independently associated with a worse outcome. Conclusion: In a large population with TS, high HR on admission independently predicted complicated in-hospital course.

AB - Background: In-hospital course of patients with Takotsubo syndrome (TS) is quite heterogeneous and life-threatening complications are not uncommon in the acute phase. The role of heart rate (HR) as a predictor of prognosis has not been sufficiently investigated in this setting. The study aims to assess the impact of HR at presentation on in-hospital course of patients with TS. Methods: The study population included 221 patients with TS enrolled in a multicentric registry. HR at admission was evaluated on the first electrocardiogram. According to tertile distribution of HR at presentation, 3 groups were identified: Group A (HR ≤ 76 beats per minute (bpm), n = 76), Group B (HR 77–95 bpm, n = 74) and Group C (HR > 95 bpm, n = 71). Acute in-hospital complications were defined as occurrence of severe pump failure and major arrhythmias. Results: 32 (14.4%) patients experienced complicated in-hospital course. HR on admission was significantly higher (108 bpm vs. 85 bpm; p < 0.001) and ejection fraction (EF) lower (35% vs. 40%; p = 0.009) in patients with complications than in those without. Patients in Group C experienced a 5-fold higher rate of complications compared to group A and B. After multivariate analysis, higher HR (odds ratio 1.34 per 10 bpm increase, 95% confidence interval (CI) 1.12–1.59; p = 0.001) and lower EF (odds ratio 1.24 per 5% decrease, 95% CI 1.01–1.54; p = 0.049) remained independently associated with a worse outcome. Conclusion: In a large population with TS, high HR on admission independently predicted complicated in-hospital course.

KW - Acute pulmonary oedema

KW - Heart rate

KW - Prognosis

KW - Shock

KW - Takotsubo syndrome

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