Aims Takotsubo syndrome (TTS) is associated to serious adverse in-hospital complications. We evaluated the role of invasively assessed left ventricular end-diastolic pressure (LVEDP) for predicting in-hospital complications in TTS patients compared to the most widely used echocardiographic parameters of ventricular function. Methods and Results We prospectively enrolled 130 patients (mean age 71.2 ± 11.3 years, 114 [87.7%] female) with TTS. Invasive measurement of LVEDP was performed at the time of cardiac catheterization. The rate of in-hospital complications (composite of acute heart failure, life-threatening arrhythmias and all-cause death) was examined. In-hospital complications occurred in 37 (28.5%) patients. Patients who experienced in-hospital complications had a higher prevalence of neurological trigger and lower prevalence of emotional trigger, higher LVEDP and mean E/e′ ratio and lower LV ejection fraction (LVEF) values compared to those who did not experience in-hospital complications. At multivariate logistic regression, higher LVEDP [odds ratio (OR) 1.12, 95% confidence interval (CI) [1.05–1.20], P < 0.001] and lower LVEF (OR 0.95, 95% CI [0.91–0.99], P = 0.011) remained independently predictors of in-hospital complications, while emotional trigger was associated to a lower risk (OR 0.24, 95% CI [0.06–0.96], P = 0.044). The area under the curve (AUC) for LEVDP in the prediction of in-hospital events was 0.776 (95% CI [0.69–0.86], P <0.001, with a sensitivity and specificity of 95% and 58% using a LVEDP cut-off value of 22.5 mmHg). The AUC was significantly higher for LVEDP than for E/e′ ratio (P = 0.037). Conclusions LVEDP measured at the time of catheterization may help in identifying TTS patients at higher risk of cardiovascular deterioration with relevant therapeutic implications.

中文翻译：

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左心室舒张末期压力可预测 takotsubo 综合征的住院结局

目的 Takotsubo 综合征 (TTS) 与严重的院内不良并发症有关。与最广泛使用的心室功能超声心动图参数相比，我们评估了侵入性评估的左心室舒张末期压力 (LVEDP) 在预测 TTS 患者住院并发症中的作用。方法和结果 我们前瞻性地招募了 130 名 TTS 患者（平均年龄 71.2 ± 11.3 岁，114 名 [87.7%] 女性）。在心导管插入术时进行 LVEDP 的侵入性测量。检查了住院并发症的发生率（急性心力衰竭、危及生命的心律失常和全因死亡）。37 名 (28.5%) 患者出现院内并发症。与未发生院内并发症的患者相比，发生院内并发症的患者神经系统触发发生率较高，情绪触发发生率较低，LVEDP 和平均 E/e' 比值较高，左室射血分数 (LVEF) 值较低. 在多元逻辑回归中，较高的 LVEDP [优势比 (OR) 1.12, 95% 置信区间 (CI) [1.05–1.20], P <; 0.001] 和较低的 LVEF (OR 0.95, 95% CI [0.91–0.99], P = 0.011) 仍然是院内并发症的独立预测因子，而情绪触发与较低的风险相关 (OR 0.24, 95% CI [0.06– 0.96]，P = 0.044）。LEVDP 预测住院事件的曲线下面积 (AUC) 为 0.776 (95% CI [0.69–0.86], P <0.001，使用 LVEDP 切割的敏感性和特异性分别为 95% 和 58% -off 值为 22.5 mmHg）。LVEDP 的 AUC 显着高于 E/e' 比 (P = 0.037)。结论 导管插入时测量的 LVEDP 可能有助于识别具有相关治疗意义的心血管恶化风险较高的 TTS 患者。