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Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry
I. El-Battrawy, VL. Cammann, K. Kato, KA. Szawan, D. Di Vece, A. Rossi, M. Wischnewsky, J. Hermes-Laufer, S. Gili, R. Citro, E. Bossone, M. Neuhaus, J. Franke, B. Meder, M. Jaguszewski, M. Noutsias, M. Knorr, S. Heiner, F. D'Ascenzo, W. Dichtl,...
Language English Country Great Britain
Document type Journal Article, Multicenter Study, Research Support, Non-U.S. Gov't
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- MeSH
- Time Factors MeSH
- Atrial Fibrillation diagnosis epidemiology mortality therapy MeSH
- Risk Assessment MeSH
- Middle Aged MeSH
- Humans MeSH
- Hospital Mortality MeSH
- Prevalence MeSH
- Patient Admission MeSH
- Prognosis MeSH
- Prospective Studies MeSH
- Registries MeSH
- Retrospective Studies MeSH
- Risk Factors MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Takotsubo Cardiomyopathy diagnosis epidemiology mortality therapy MeSH
- Check Tag
- Middle Aged MeSH
- Humans MeSH
- Male MeSH
- Aged, 80 and over MeSH
- Aged MeSH
- Female MeSH
- Publication type
- Journal Article MeSH
- Multicenter Study MeSH
- Research Support, Non-U.S. Gov't MeSH
- Geographicals
- Europe MeSH
- United States MeSH
Background Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS. Methods and Results Patients with TTS were enrolled from the International Takotsubo Registry, which is a multinational network with 26 participating centers in Europe and the United States. Patients were dichotomized according to the presence or absence of AF at the time of admission. Of 1584 patients with TTS, 112 (7.1%) had AF. The mean age was higher (P<0.001), and there were fewer women (P=0.046) in the AF than in the non-AF group. Left ventricular ejection fraction was significantly lower (P=0.001), and cardiogenic shock was more often observed (P<0.001) in the AF group. Both in-hospital (P<0.001) and long-term mortality (P<0.001) were higher in the AF group. Multivariable Cox regression analysis revealed that AF was independently associated with higher long-term mortality (hazard ratio, 2.31; 95% CI, 1.50-3.55; P<0.001). Among patients with AF on admission, 42% had no known history of AF before the acute TTS event, and such patients had comparable in-hospital and long-term outcomes compared with those with a history of AF. Conclusions In patients presenting with TTS, AF on admission is significantly associated with increased in-hospital and long-term mortality rates. Whether antiarrhythmics and/or cardioversion are beneficial in TTS with AF should thus be tested in a future trial. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01947621.
1st Department of Cardiology Medical University of Gdansk Gdansk Poland
Center for Cardiology Cardiology 1 University Medical Center Mainz Mainz Germany
Center for Molecular Cardiology Schlieren Campus University of Zurich Zurich Switzerland
Centro cardiologico MonzinoIRCCS Milan Italy
Clinic for Cardiology and Pneumology Georg August University Goettingen Goettingen Germany
Department of Cardiology and Angiology Hannover Medical School Hannover Germany
Department of Cardiology and Cardiac Imaging Center University Hospital of Rangueil Toulouse France
Department of Cardiology and Internal Medicine B University Medicine Greifswald Greifswald Germany
Department of Cardiology Centro Hospitalar Universitário de São JoãoE P E Porto Portugal
Department of Cardiology CharitéCampus Rudolf Virchow Berlin Germany
Department of Cardiology Christchurch Hospital Christchurch New Zealand
Department of Cardiology Heidelberg University Hospital Heidelberg Germany
Department of Cardiology John Radcliffe HospitalOxford University Hospitals Oxford United Kingdom
Department of Cardiology Kantonsspital Frauenfeld Frauenfeld Switzerland
Department of Cardiology Kantonsspital Lucerne Lucerne Switzerland
Department of Cardiology Kantonsspital St Gallen St Gallen Switzerland
Department of Cardiology Kantonsspital Winterthur Winterthur Switzerland
Department of Cardiology King's College Hospital London United Kingdom
Department of Cardiology Leiden University Medical Centre Leiden The Netherlands
Department of Cardiology Medical University of Warsaw Warsaw Poland
Department of Cardiology University Heart CenterUniversity Hospital Zurich Zurich Switzerland
Department of Cardiology University Hospital Basel Basel Switzerland
Department of Cardiovascular Diseases Mayo Clinic Rochester MN
Department of Cardiovascular Medicine Chiba University Graduate School of Medicine Chiba Japan
Department of General and Interventional Cardiology University Heart Center Hamburg Hamburg Germany
Department of Internal Medicine 1 Cardiology University Hospital Olomouc Olomouc Czech Republic
Department of Internal Medicine 2 Cardiology University of UlmMedical Center Ulm Germany
Department of Internal Medicine 3 Heart Center University of Cologne Cologne Germany
Department of Internal Medicine Cardiology and Angiology Magdeburg University Magdeburg Germany
Department of Internal Medicine Cardiology Heart Center Leipzig University Hospital Leipzig Germany
Deutsches Herzzentrum MünchenTechnische Universität München Munich Germany
Division of Cardiology A O U San Luigi Gonzaga Orbassano Turin Italy
Division of Cardiology Antonio Cardarelli Hospital Naples Italy
Division of Cardiology Heart and Vascular Center University of Iowa Iowa City IA
FB Mathematics and Computer Science University of Bremen Bremen Germany
Fondazione Policlinico Universitario A Gemelli IRCCSUniversità Cattolica del Sacro Cuore Rome Italy
German Center for Cardiovascular Researchpartner site Heidelberg Mannheim Mannheim Germany
German Centre for Cardiovascular Research partner site Hamburg Kiel Luebeck Hamburg Germany
German Centre for Cardiovascular Research partner site Munich Heart Alliance Munich Germany
German Centre for Cardiovascular Researchpartner site Greifswald Greifswald Germany
Heart and Vascular Centre Bad Bevensen Bad Bevensen Germany
Heart Center Turku University Hospital and University of Turku Turku Finland
Heart Department University Hospital San Giovanni di Dio e Ruggi d'Aragona Salerno Italy
Intensive Coronary Care Unit Moscow City Hospital 1 named after N Pirogov Moscow Russia
Keck School of Medicine University of Southern California Los Angeles CA
Klinik für Innere Medizin IIIUniversitätsklinikum des Saarlandes Homburg Germany
Klinik und Poliklinik für Innere Medizin 2 Universitätsklinikum Regensburg Regensburg Germany
Krankenhaus Maria Hilf Medizinische Klinik Stadtlohn Germany
Local Health Unit N 8 Cardiology Unit Vicenza Italy
Royal Brompton and Harefield Hospitals Trust and Imperial College London United Kingdom
Service de Cardiologie Hôpitaux Universitaires de Genève Geneva Switzerland
Structural Interventional Cardiology Careggi University Hospital Florence Italy
TJ Health Partners Heart and Vascular Glasgow KY
University Hospital for Internal Medicine 3 Medical University Innsbruck Innsbruck Austria
References provided by Crossref.org
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- $a Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry / $c I. El-Battrawy, VL. Cammann, K. Kato, KA. Szawan, D. Di Vece, A. Rossi, M. Wischnewsky, J. Hermes-Laufer, S. Gili, R. Citro, E. Bossone, M. Neuhaus, J. Franke, B. Meder, M. Jaguszewski, M. Noutsias, M. Knorr, S. Heiner, F. D'Ascenzo, W. Dichtl, C. Burgdorf, B. Kherad, C. Tschöpe, A. Sarcon, J. Shinbane, L. Rajan, G. Michels, R. Pfister, A. Cuneo, C. Jacobshagen, M. Karakas, W. Koenig, A. Pott, P. Meyer, J. David Arroja, A. Banning, F. Cuculi, R. Kobza, TA. Fischer, T. Vasankari, KEJ. Airaksinen, LC. Napp, M. Budnik, R. Dworakowski, P. MacCarthy, C. Kaiser, S. Osswald, L. Galiuto, C. Chan, P. Bridgman, D. Beug, C. Delmas, O. Lairez, E. Gilyarova, A. Shilova, M. Gilyarov, M. Kozel, P. Tousek, DE. Winchester, J. Galuszka, C. Ukena, G. Poglajen, P. Carrilho-Ferreira, C. Hauck, C. Paolini, C. Bilato, Y. Kobayashi, A. Prasad, CS. Rihal, K. Liu, PC. Schulze, M. Bianco, L. Jörg, H. Rickli, G. Pestana, TH. Nguyen, M. Böhm, LS. Maier, FJ. Pinto, P. Widimský, SB. Felix, G. Opolski, RC. Braun-Dullaeus, W. Rottbauer, G. Hasenfuß, BM. Pieske, H. Schunkert, H. Thiele, J. Bauersachs, HA. Katus, JD. Horowitz, C. Di Mario, T. Münzel, F. Crea, JJ. Bax, TF. Lüscher, F. Ruschitzka, F. Duru, M. Borggrefe, JR. Ghadri, I. Akin, C. Templin
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- $a Background Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS. Methods and Results Patients with TTS were enrolled from the International Takotsubo Registry, which is a multinational network with 26 participating centers in Europe and the United States. Patients were dichotomized according to the presence or absence of AF at the time of admission. Of 1584 patients with TTS, 112 (7.1%) had AF. The mean age was higher (P<0.001), and there were fewer women (P=0.046) in the AF than in the non-AF group. Left ventricular ejection fraction was significantly lower (P=0.001), and cardiogenic shock was more often observed (P<0.001) in the AF group. Both in-hospital (P<0.001) and long-term mortality (P<0.001) were higher in the AF group. Multivariable Cox regression analysis revealed that AF was independently associated with higher long-term mortality (hazard ratio, 2.31; 95% CI, 1.50-3.55; P<0.001). Among patients with AF on admission, 42% had no known history of AF before the acute TTS event, and such patients had comparable in-hospital and long-term outcomes compared with those with a history of AF. Conclusions In patients presenting with TTS, AF on admission is significantly associated with increased in-hospital and long-term mortality rates. Whether antiarrhythmics and/or cardioversion are beneficial in TTS with AF should thus be tested in a future trial. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01947621.
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