Peri‐operative Takotsubo syndrome after non‐cardiac surgery: a retrospective nested case–control study
Abstract Aims Takotsubo syndrome (TTS) is an acute reversible cardiac dysfunction that may occur during the peri‐operative period and among patients with serious illness. We aimed to evaluate the clinical characteristics, peri‐operative management, and prognosis of peri‐operative TTS (pTTS) and expl...
| Main Authors: | , , , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Wiley
2022-10-01
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| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.14015 |
| _version_ | 1797794295488446464 |
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| author | Zhi Shang Menglin Zhao Jiageng Cai Cencen Wu Yuan Xu Lin Zeng Hong Cai Mao Xu Yuanyuan Fan Yanguang Li Wei Gao Weixian Xu Lingyun Zu |
| author_facet | Zhi Shang Menglin Zhao Jiageng Cai Cencen Wu Yuan Xu Lin Zeng Hong Cai Mao Xu Yuanyuan Fan Yanguang Li Wei Gao Weixian Xu Lingyun Zu |
| author_sort | Zhi Shang |
| collection | DOAJ |
| description | Abstract Aims Takotsubo syndrome (TTS) is an acute reversible cardiac dysfunction that may occur during the peri‐operative period and among patients with serious illness. We aimed to evaluate the clinical characteristics, peri‐operative management, and prognosis of peri‐operative TTS (pTTS) and explore the factors associated with pTTS. Methods We conducted a retrospective nested case–control study using the database of patients who underwent in‐hospital non‐cardiac surgeries between January 2017 and December 2020 in Peking University Third hospital. Cases were adult patients diagnosed TTS at discharge who were matched with four controls based on operative types. Multivariable conditional logistic regression was used to identified the factors associated with pTTS. The area under the curve (AUC) was used to evaluate the diagnostic efficacy. Results Among the 128 536 patients underwent non‐cardiac surgery, 20 patients with pTTS and 80 patients without were enrolled in this study. The incidence of pTTS was about 0.016% in our centre. The median age of patients with pTTS was 52.5 (38.25, 76.25) years, although 90% of them were female. Fifty per cent (9 cases) of female patients were pre‐menopausal. Caesarean section has the highest proportion of pTTS (30% of the pTTS cases) with the incidence of caesarean section‐related pTTS of 0.06% in our centre. A high prevalence of non‐apical ballooning pattern of regional wall motion abnormality (seven cases, 35%) and a high mortality (two cases, 10%) were observed. Left ventricular ejection fraction (LVEF) of patients with pTTS was significantly decreased (41.7 ± 8.8%). In the acute phase, supportive treatments aiming to reduce life‐threatening complications were main treatment strategies. After receiving systematic treatment, significant improvements were observed in LVEF (63.1 ± 13.5%), with median recovery time of LVEF of 7.48 days. Leucocyte count [odds ratio (OR): 4.59; 95% confidence interval (CI): 1.10–19.15], haemoglobin (HGB) (OR: 10.52; 95% CI: 1.04–106.36), and the revised cardiac risk index (RCRI) score (OR: 6.30; 95% CI: 1.05–37.88) were the factors significantly associated with pTTS. The RCRI score performed poorly in the prediction of pTTS (AUC: 0.630; 95% CI: 0.525–0.735). After adding leucocyte count and HGB into the RCRI score, the AUC was significantly improved (AUC: 0.768; 95% CI: 0.671–0.865; P = 0.001). Conclusions Patients with pTTS have some differences compared with common TTS, including higher proportion of pre‐menopausal female, higher prevalence during caesarean section, higher prevalence of non‐apical ballooning pattern of regional wall motion abnormality, and higher mortality. The RCRI score performed poorly in the evaluation of pTTS. Adding HGB and leucocyte count into the RCRI score could significantly improve its predictive performance. |
| first_indexed | 2024-03-13T03:00:38Z |
| format | Article |
| id | doaj.art-7d3cb02b52f142d1b6182b5981cad1fd |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-03-13T03:00:38Z |
| publishDate | 2022-10-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-7d3cb02b52f142d1b6182b5981cad1fd2023-06-27T14:49:57ZengWileyESC Heart Failure2055-58222022-10-01953149315910.1002/ehf2.14015Peri‐operative Takotsubo syndrome after non‐cardiac surgery: a retrospective nested case–control studyZhi Shang0Menglin Zhao1Jiageng Cai2Cencen Wu3Yuan Xu4Lin Zeng5Hong Cai6Mao Xu7Yuanyuan Fan8Yanguang Li9Wei Gao10Weixian Xu11Lingyun Zu12Department of Cardiology and Institute of Vascular Medicine Peking University Third Hospital Beijing ChinaDepartment of Cardiology and Institute of Vascular Medicine Peking University Third Hospital Beijing ChinaDepartment of Cardiology and Institute of Vascular Medicine Peking University Third Hospital Beijing ChinaDepartment of Cardiology and Institute of Vascular Medicine Peking University Third Hospital Beijing ChinaDepartment of Cardiology and Institute of Vascular Medicine Peking University Third Hospital Beijing ChinaResearch Center of Clinical Epidemiology Peking University Third Hospital Beijing ChinaDepartment of Cardiology and Institute of Vascular Medicine Peking University Third Hospital Beijing ChinaDepartment of Cardiology and Institute of Vascular Medicine Peking University Third Hospital Beijing ChinaDepartment of Cardiology and Institute of Vascular Medicine Peking University Third Hospital Beijing ChinaDepartment of Cardiology and Institute of Vascular Medicine Peking University Third Hospital Beijing ChinaDepartment of Cardiology and Institute of Vascular Medicine Peking University Third Hospital Beijing ChinaDepartment of Cardiology and Institute of Vascular Medicine Peking University Third Hospital Beijing ChinaDepartment of Cardiology and Institute of Vascular Medicine Peking University Third Hospital Beijing ChinaAbstract Aims Takotsubo syndrome (TTS) is an acute reversible cardiac dysfunction that may occur during the peri‐operative period and among patients with serious illness. We aimed to evaluate the clinical characteristics, peri‐operative management, and prognosis of peri‐operative TTS (pTTS) and explore the factors associated with pTTS. Methods We conducted a retrospective nested case–control study using the database of patients who underwent in‐hospital non‐cardiac surgeries between January 2017 and December 2020 in Peking University Third hospital. Cases were adult patients diagnosed TTS at discharge who were matched with four controls based on operative types. Multivariable conditional logistic regression was used to identified the factors associated with pTTS. The area under the curve (AUC) was used to evaluate the diagnostic efficacy. Results Among the 128 536 patients underwent non‐cardiac surgery, 20 patients with pTTS and 80 patients without were enrolled in this study. The incidence of pTTS was about 0.016% in our centre. The median age of patients with pTTS was 52.5 (38.25, 76.25) years, although 90% of them were female. Fifty per cent (9 cases) of female patients were pre‐menopausal. Caesarean section has the highest proportion of pTTS (30% of the pTTS cases) with the incidence of caesarean section‐related pTTS of 0.06% in our centre. A high prevalence of non‐apical ballooning pattern of regional wall motion abnormality (seven cases, 35%) and a high mortality (two cases, 10%) were observed. Left ventricular ejection fraction (LVEF) of patients with pTTS was significantly decreased (41.7 ± 8.8%). In the acute phase, supportive treatments aiming to reduce life‐threatening complications were main treatment strategies. After receiving systematic treatment, significant improvements were observed in LVEF (63.1 ± 13.5%), with median recovery time of LVEF of 7.48 days. Leucocyte count [odds ratio (OR): 4.59; 95% confidence interval (CI): 1.10–19.15], haemoglobin (HGB) (OR: 10.52; 95% CI: 1.04–106.36), and the revised cardiac risk index (RCRI) score (OR: 6.30; 95% CI: 1.05–37.88) were the factors significantly associated with pTTS. The RCRI score performed poorly in the prediction of pTTS (AUC: 0.630; 95% CI: 0.525–0.735). After adding leucocyte count and HGB into the RCRI score, the AUC was significantly improved (AUC: 0.768; 95% CI: 0.671–0.865; P = 0.001). Conclusions Patients with pTTS have some differences compared with common TTS, including higher proportion of pre‐menopausal female, higher prevalence during caesarean section, higher prevalence of non‐apical ballooning pattern of regional wall motion abnormality, and higher mortality. The RCRI score performed poorly in the evaluation of pTTS. Adding HGB and leucocyte count into the RCRI score could significantly improve its predictive performance.https://doi.org/10.1002/ehf2.14015Peri‐operative Takotsubo syndromeCaesarean sectionRevised cardiac risk indexLeucocyteHaemoglobinNested case–control study |
| spellingShingle | Zhi Shang Menglin Zhao Jiageng Cai Cencen Wu Yuan Xu Lin Zeng Hong Cai Mao Xu Yuanyuan Fan Yanguang Li Wei Gao Weixian Xu Lingyun Zu Peri‐operative Takotsubo syndrome after non‐cardiac surgery: a retrospective nested case–control study ESC Heart Failure Peri‐operative Takotsubo syndrome Caesarean section Revised cardiac risk index Leucocyte Haemoglobin Nested case–control study |
| title | Peri‐operative Takotsubo syndrome after non‐cardiac surgery: a retrospective nested case–control study |
| title_full | Peri‐operative Takotsubo syndrome after non‐cardiac surgery: a retrospective nested case–control study |
| title_fullStr | Peri‐operative Takotsubo syndrome after non‐cardiac surgery: a retrospective nested case–control study |
| title_full_unstemmed | Peri‐operative Takotsubo syndrome after non‐cardiac surgery: a retrospective nested case–control study |
| title_short | Peri‐operative Takotsubo syndrome after non‐cardiac surgery: a retrospective nested case–control study |
| title_sort | peri operative takotsubo syndrome after non cardiac surgery a retrospective nested case control study |
| topic | Peri‐operative Takotsubo syndrome Caesarean section Revised cardiac risk index Leucocyte Haemoglobin Nested case–control study |
| url | https://doi.org/10.1002/ehf2.14015 |
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