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Observational Study
. 2018 Mar 20;18(1):54.
doi: 10.1186/s12872-018-0784-6.

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

Uzair Ansari  1   2 , Ibrahim El-Battrawy  3   4 , Christian Fastner  3 , Michael Behnes  3 , Katherine Sattler  3 , Aydin Huseynov  3 , Stefan Baumann  3 , Erol Tülümen  3 , Martin Borggrefe  3   4 , Ibrahim Akin  3   4
Affiliations
Observational Study

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

Uzair Ansari et al. BMC Cardiovasc Disord. .

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.

Keywords: Cardiogenic shock; Catecholamines; Heart failure; Takotsubo cardiomyopathy.

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Conflict of interest statement

Ethics approval and consent to participate

Approved by the medical ethics committee of the Faculty of Medicine in Mannheim, University of Heidelberg, Germany. As this was a retrospective study, the ethics committee waivered the need for informed consent.

Consent for publication

As this was a retrospective study, consent from included patients was not required.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1
Fig. 1
Flow Diagram of study
Fig. 2
Fig. 2
Log-rank and survival rates of patients treated and not treated with catecholamines
See this image and copyright information in PMC

Comment in

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