Takotsubo cardiomyopathy with low ventricular ejection fraction and apical ballooning predicts mortality: a systematic r
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Takotsubo cardiomyopathy with low ventricular ejection fraction and apical ballooning predicts mortality: a systematic review and meta-analysis Lorraine Lok-Wing Chiang 1 & Shek Long Tsang 1 & Jing Xian Lee 2 & Mengqi Gong 3 & Tong Liu 3 & Gary Tse 4 Dong Chang 4 & Ishan Lakhani 5 & Ka Hou Christien Li 2
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Accepted: 21 August 2020 # Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Takotsubo cardiomyopathy (TCM) is characterized by temporary wall motion abnormality of the left ventricle. There is much debate upon the prognostic parameters. We conducted a systematic review and meta-analysis to investigate whether LVEF and the presence of apical ballooning predict long-term mortality in TCM. PubMed and Embase were searched through to October 30, 2017 without language restrictions, followed by an additional search through to February 2, 2020. Our search identified 18 studies that met the inclusion criteria, with a total of 5168 patients. Reduced LVEF as a categorical variable was associated with more than threefold increase in mortality risk in TCM patients (HR 3.10; 95% CI 1.78–5.42; P < 0.0001; I2 = 57%). Further subset analyses with the exclusion of studies consisting of patients with coronary artery disease revealed another significant relationship between LVEF and mortality (HR 3.13; 95% CI 1.392–7.031; P < 0.006; I2 = 58%). LVEF as a continuous variable was also found to be associated with increased mortality risk. However, this relationship only retained significance when computing odds ratios instead of hazard ratios (OR 0.95; 95% CI 0.93–0.98; P < 0.001; I2 = 0%). Finally, the existence of apical ballooning failed to demonstrate any link with an increased risk of mortality (HR 1.26; 95% CI 0.97–1.64; P = 0.09; I2 = 34%). LVEF and apical ballooning are both potential prognostic markers for mortality. Keywords Takotsubo cardiomyopathy . Ejection fraction . Apical ballooning . Mortality
Introduction Takotsubo cardiomyopathy (TCM), also termed Takotsubo syndrome or stress cardiomyopathy, is a reversible disease commonly affecting postmenopausal
women, characterized by transient ventricular wall motion abnormalities mediated by physical or mental stress [1–3]. There is much uncertainty regarding the pathogenesis of TCM. With the many different postulations proposed, the theory that has seemed to gain significant credence is the
Lorraine Lok-Wing Chiang, and Shek Long Tsang are authors who share first position. Ishan Lakhani, and Ka Hou Christien are authors who share the corresponding author position. Electronic supplementary material The online version of this article (https://doi.org/10.1007/s10741-020-10018-0) contains supplementary material, which is available to authorized users. * Ishan Lakhani [email protected]
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Tianjin Key Laboratory of Ionic-Molecular Function of Cardiovascular disease, Department of Cardiology, Tianjin Institute of Cardiology, Second Hospital of Tianjin Medical University, Tianjin 300211, China
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Xiamen Cardiovascular Hospital Affiliated to Xi
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