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Observational Study
. 2020 Aug 28;115(2):207-216.
doi: 10.36660/abc.20190166.

Takotsubo Multicenter Registry (REMUTA) - Clinical Aspects, In-Hospital Outcomes, and Long-Term Mortality

[Article in English, Portuguese]
Gustavo Luiz Gouvêa de Almeida Junior  1 , João Mansur Filho  2 , Denilson Campos de Albuquerque  3   4 , Sergio Salles Xavier  5 , Álvaro Pontes  4 , Elias Pimentel Gouvêa  4 , Alexandre Bahia Barreiras Martins  6 , Nágela S V Nunes  7   8 , Lilian Vieira Carestiato  4   9 , João Luiz Fernandes Petriz  4 , Armando Márcio Gonçalves Santos  4 , Bruno Santana Bandeira  4 , Bárbara Elaine de Jesus Abufaiad  4 , Luciana da Camara Pacheco  1 , Maurício Sales de Oliveira  4 , Paulo Eduardo Campana Ribeiro Filho  4 , Pedro Paulo Nogueres Sampaio  2 , Gustavo Salgado Duque  3   6 , Luiz Felipe Camillis  9 , André Casarsa Marques  4 , Francisco Carlos Lourenço Jr  4 , José Ricardo Palazzo  4 , Cláudio Ramos da Costa  4 , Bibiana Almeida da Silva  1 , Cleverson Neves Zukowski  4 , Romulo Ribeiro Garcia  2 , Fernanda de Carvalho Zonis  9 , Suzana Andressa Morais de Paula  4 , Carolina Gravano Ferraz Ferrari  4 , Bruno Soares da Silva Rangel  1 , Roberto Muniz Ferreira  2   10 , Bárbara Ferreira da Silva Mendes  4 , Isabela Ribeiro Carvalho de Castro  1 , Leonardo Giglio Gonçalves de Souza  1 , Luiz Henrique Dos Santos Araújo  1 , Alexandre Giani  4
Affiliations
Observational Study

Takotsubo Multicenter Registry (REMUTA) - Clinical Aspects, In-Hospital Outcomes, and Long-Term Mortality

[Article in English, Portuguese]
Gustavo Luiz Gouvêa de Almeida Junior et al. Arq Bras Cardiol. .

Abstract
in English, Portuguese

Background: Takotsubo syndrome (TTS) is an acquired form of cardiomyopathy. National Brazilian data on this condition are scarce. The Takotsubo Multicenter Registry (REMUTA) is the first to include multicenter data on this condition in Brazil.

Objective: To describe the clinical characteristics, prognosis, in-hospital treatment, in-hospital mortality, and mortality during 1 year of follow-up.

Methods: This is an observational, retrospective registry study including patients admitted to the hospital with diagnosis of TTS and patients admitted for other reasons who developed this condition. Evaluated outcomes included triggering factor, analysis of exams, use of medications, complications, in-hospital mortality, and mortality during 1 year of follow-up. A significance level of 5% was adopted.

Results: The registry included 169 patients from 12 centers in the state of Rio de Janeiro, Brazil. Mean age was 70.9 ± 14.1 years, and 90.5% of patients were female; 63% of cases were primary TTS, and 37% were secondary. Troponin I was positive in 92.5% of patients, and median BNP was 395 (176.5; 1725). ST-segment elevation was present in 28% of patients. Median left ventricular ejection fraction was 40 (35; 48)%. We observed invasive mechanical ventilation in 25.7% of cases and shock in 17.4%. Mechanical circulatory support was used in 7.7%. In-hospital mortality was 10.6%, and mortality at 1 year of follow-up was 16.5%. Secondary TTS and cardiogenic shock were independent predictors of mortality.

Conclusion: The results of the REMUTA show that TTS is not a benign pathology, as was once thought, especially regarding the secondary TTS group, which has a high rate of complications and mortality. (Arq Bras Cardiol. 2020; 115(2):207-216).

Fundamento: A síndrome de takotsubo (takotsubo) é uma forma de cardiomiopatia adquirida. Dados nacionais sobre essa condição são escassos. O Registro REMUTA é o primeiro a incluir dados multicêntricos dessa condição no nosso país.

Objetivo: Descrever as características clínicas, prognóstico, tratamento intra-hospitalar e mortalidade hospitalar e em 1 ano de seguimento.

Métodos: Estudo observacional, retrospectivo, tipo registro. Incluídos pacientes internados com diagnóstico de takotsubo ou que desenvolveram esta condição durante internação por outra causa. Os desfechos avaliados incluíram fator desencadeador, análise dos exames, uso de medicações, complicações e óbito intra-hospitalar e em 1 ano de seguimento. O nível de significância adotado foi de 5%.

Resultados: Foram incluídos 169 pacientes, em 12 centros no Estado do Rio de Janeiro. A idade média foi de 70,9 ± 14,1 anos e 90,5% eram do sexo feminino; 63% dos casos foram de takotsubo primário e 37% secundário. Troponina I foi positiva em 92,5% dos pacientes e a mediana de BNP foi de 395 (176,5; 1725). Supradesnivelamento do segmento ST esteve presente em 28% dos pacientes. A fração de ejeção do ventrículo esquerdo teve mediana de 40 (35; 48)%. Observamos taxa de 25,7% de ventilação mecânica invasiva e 17,4% de choque. Suporte circulatório mecânico foi utilizado em 7,7%. A mortalidade intra-hospitalar foi de 10,6% e a mortalidade ao final de 1 ano foi de 16,5%. Takotsubo secundário e choque cardiogênico foram preditores independentes de mortalidade.

Conclusão: Os resultados do REMUTA mostram que takotsubo não se trata de patologia benigna como se pensava, especialmente no grupo de takotsubo secundário que acarreta elevada taxa de complicações e de mortalidade. (Arq Bras Cardiol. 2020; 115(2):207-216).

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Conflict of interest statement

Potencial conflito de interesses

Declaro não haver conflito de interesses pertinentes.

Figures

Figura 1
Figura 1. – Padrão de alteração segmentar de contração.
Figura 2
Figura 2. – Fármacos utilizados durante a internação. Espirono: espironolactona; Nora: noradrenalina; IECA: inibidor do receptor da angiotensina; BRA: bloqueador do receptor da angiotensina.
Figura 3
Figura 3. – Complicações intra-hospitalares. PCR: Parada cardiorrespiratória; Sup. Circ: Suporte circulatório; EAP: Edema agudo de pulmão, VNI: ventilação não-invasiva; Vent. Mec ventilação mecânica invasiva.
Figura 4
Figura 4. – Sobrevida total em 1 ano.
Figura 5
Figura 5. – Preditores independentes de mortalidade. A: Sobrevida em 1 ano segundo tipo de takotsubo; B: Sobrevida em 1 ano segundo presença de choque; C: Sobrevida em 1 ano segundo presença de dor torácica na admissão.
Figure 1
Figure 1. – Changes in segmental contraction patterns
Figure 2
Figure 2. – Medications used during hospital stay. ACEI: angiotensin converting enzyme inhibitors; ARB: angiotensin receptor blockers
Figure 3
Figure 3. – In-hospital complications. PCR: APE acute pulmonary edema; CRA: cardiorespiratory arrest; IMV: invasive mechanical ventilation; NIMV: non-invasive mechanical ventilation.
Figure 4
Figure 4. – Overall 1-year survival.
Figure 5
Figure 5. – Independent predictors of mortality. A: One-year survival according to type of takotsubo syndrome; B: One-year survival according to the presence of shock; C: One-year survival according to the presence of chest pain at admission
See this image and copyright information in PMC

Comment in

References

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