Risk stratification in Takotsubo syndrome: A role of mitral annular plane systolic excursion

Abstract

Aim: Takotsubo syndrome (TTS) patients have a higher mortality rate than the general population. Our study was conducted to determine the short- and long-term outcome of TTS patients associated with a significantly compromised mitral annular plane systolic excursion (MAPSE) on hospital admission. Methods and results: Our institutional database constituted a collective of 53 patients diagnosed with TTS between 2003 and 2016. The patients were classified into two groups based on the MAPSE, with those presenting with an MAPSE<1cmon admission categorized into one group (n=20, 38%) and those presenting with MAPSE≥1cm(n=33, 62%) categorized into another group. Preliminary results indicated that patients with an MAPSE<1 cmhad a greater risk of developing thromboembolic events. The long-termmortality was significantly higher in TTS patients with an MAPSE<1 cm. In the multivariate Cox regression analysis, cardiogenic shock (hazard ratio 3.5; 95% confidence interval: 1.2-10.7; P=0.02) and MAPSE<1cm (hazard ratio 5.1; 95% confidence interval: 1.3-19.2; P=0.01) figured as independent predictors of the mortality. Conclusion: Although the short-term mortality rates among TTS patients diagnosed with a reduced MAPSE on admissionwere as similar as without reduced MAPSE, the long-termmortality rates among TTS patients diagnosed with a reduced MAPSE on admission were significantly higher. There is an urgent need for randomized trials, which could help define uniform clinical management strategies for high-risk TTS patients.