Impact of residual inflammation on myocardial recovery and cardiovascular outcome in Takotsubo patients
Abstract Aims Recent insights have emphasized the importance of myocardial and systemic inflammation in Takotsubo syndrome (TTS). In a large registry of unselected patients, we sought to evaluate whether residual high inflammatory response (RHIR) could impact cardiovascular outcome after TTS. Method...
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Format: | Article |
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Wiley
2021-02-01
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Series: | ESC Heart Failure |
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Online Access: | https://doi.org/10.1002/ehf2.12945 |
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doaj-9e047e76d0a64c808256bf398b055521 |
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record_format |
Article |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Lucie Lachmet‐Thebaud Benjamin Marchandot Kensuke Matsushita Chisato Sato Charlotte Dagrenat Stephane Greciano Fabien De Poli Pierre Leddet Marilou Peillex Sébastien Hess Adrien Carmona Charline Jimenez Joe Heger Antje Reydel Patrick Ohlmann Laurence Jesel Olivier Morel |
spellingShingle |
Lucie Lachmet‐Thebaud Benjamin Marchandot Kensuke Matsushita Chisato Sato Charlotte Dagrenat Stephane Greciano Fabien De Poli Pierre Leddet Marilou Peillex Sébastien Hess Adrien Carmona Charline Jimenez Joe Heger Antje Reydel Patrick Ohlmann Laurence Jesel Olivier Morel Impact of residual inflammation on myocardial recovery and cardiovascular outcome in Takotsubo patients ESC Heart Failure Takotsubo syndrome Residual high inflammatory response Systemic inflammatory response syndrome Predictive factor Late cardiac death Late cardiovascular outcome |
author_facet |
Lucie Lachmet‐Thebaud Benjamin Marchandot Kensuke Matsushita Chisato Sato Charlotte Dagrenat Stephane Greciano Fabien De Poli Pierre Leddet Marilou Peillex Sébastien Hess Adrien Carmona Charline Jimenez Joe Heger Antje Reydel Patrick Ohlmann Laurence Jesel Olivier Morel |
author_sort |
Lucie Lachmet‐Thebaud |
title |
Impact of residual inflammation on myocardial recovery and cardiovascular outcome in Takotsubo patients |
title_short |
Impact of residual inflammation on myocardial recovery and cardiovascular outcome in Takotsubo patients |
title_full |
Impact of residual inflammation on myocardial recovery and cardiovascular outcome in Takotsubo patients |
title_fullStr |
Impact of residual inflammation on myocardial recovery and cardiovascular outcome in Takotsubo patients |
title_full_unstemmed |
Impact of residual inflammation on myocardial recovery and cardiovascular outcome in Takotsubo patients |
title_sort |
impact of residual inflammation on myocardial recovery and cardiovascular outcome in takotsubo patients |
publisher |
Wiley |
series |
ESC Heart Failure |
issn |
2055-5822 |
publishDate |
2021-02-01 |
description |
Abstract Aims Recent insights have emphasized the importance of myocardial and systemic inflammation in Takotsubo syndrome (TTS). In a large registry of unselected patients, we sought to evaluate whether residual high inflammatory response (RHIR) could impact cardiovascular outcome after TTS. Methods and results Patients with TTS were retrospectively included between 2008 and 2018 in three general hospitals. Three hundred eighty‐five patients with TTS were split into three subgroups, according to tertiles of C‐reactive protein (CRP) levels at discharge (CRP <5.2 mg/L, CRP range 5.2 to 19 mg/L, and CRP >19 mg/L). The primary endpoint was the impact of RHIR, defined as CRP >19 mg/L at discharge, on cardiac death or hospitalization for heart failure. Follow up was obtained in 382 patients (99%) after a median of 747 days. RHIR patients were more likely to have a history of cancer or a physical trigger. Left ventricular ejection fraction (LVEF) at admission and at discharge were comparable between groups. By contrast, RHIR was associated with lower LVEF at follow up (61.7% vs. 60.7% vs. 57.9%; P = 0.004) and increased cardiac late mortality (0% vs. 0% vs. 10%; P = 0.001). By multivariate Cox regression analysis, RHIR was an independent predictor of cardiac death or hospitalization for heart failure (hazard ratio: 1.87; 95% confidence interval: 1.08 to 3.25; P = 0.025). Conclusions Residual high inflammatory response was associated with impaired LVEF at follow up and was evidenced as an independent factor of cardiovascular events. All together, these findings underline RHIR patients as a high‐risk subgroup, to target in future clinical trials with specific therapies to attenuate RHIR. |
topic |
Takotsubo syndrome Residual high inflammatory response Systemic inflammatory response syndrome Predictive factor Late cardiac death Late cardiovascular outcome |
url |
https://doi.org/10.1002/ehf2.12945 |
work_keys_str_mv |
AT lucielachmetthebaud impactofresidualinflammationonmyocardialrecoveryandcardiovascularoutcomeintakotsubopatients AT benjaminmarchandot impactofresidualinflammationonmyocardialrecoveryandcardiovascularoutcomeintakotsubopatients AT kensukematsushita impactofresidualinflammationonmyocardialrecoveryandcardiovascularoutcomeintakotsubopatients AT chisatosato impactofresidualinflammationonmyocardialrecoveryandcardiovascularoutcomeintakotsubopatients AT charlottedagrenat impactofresidualinflammationonmyocardialrecoveryandcardiovascularoutcomeintakotsubopatients AT stephanegreciano impactofresidualinflammationonmyocardialrecoveryandcardiovascularoutcomeintakotsubopatients AT fabiendepoli impactofresidualinflammationonmyocardialrecoveryandcardiovascularoutcomeintakotsubopatients AT pierreleddet impactofresidualinflammationonmyocardialrecoveryandcardiovascularoutcomeintakotsubopatients AT mariloupeillex impactofresidualinflammationonmyocardialrecoveryandcardiovascularoutcomeintakotsubopatients AT sebastienhess impactofresidualinflammationonmyocardialrecoveryandcardiovascularoutcomeintakotsubopatients AT adriencarmona impactofresidualinflammationonmyocardialrecoveryandcardiovascularoutcomeintakotsubopatients AT charlinejimenez impactofresidualinflammationonmyocardialrecoveryandcardiovascularoutcomeintakotsubopatients AT joeheger impactofresidualinflammationonmyocardialrecoveryandcardiovascularoutcomeintakotsubopatients AT antjereydel impactofresidualinflammationonmyocardialrecoveryandcardiovascularoutcomeintakotsubopatients AT patrickohlmann impactofresidualinflammationonmyocardialrecoveryandcardiovascularoutcomeintakotsubopatients AT laurencejesel impactofresidualinflammationonmyocardialrecoveryandcardiovascularoutcomeintakotsubopatients AT oliviermorel impactofresidualinflammationonmyocardialrecoveryandcardiovascularoutcomeintakotsubopatients |
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doaj-9e047e76d0a64c808256bf398b0555212021-03-31T03:15:44ZengWileyESC Heart Failure2055-58222021-02-018125926910.1002/ehf2.12945Impact of residual inflammation on myocardial recovery and cardiovascular outcome in Takotsubo patientsLucie Lachmet‐Thebaud0Benjamin Marchandot1Kensuke Matsushita2Chisato Sato3Charlotte Dagrenat4Stephane Greciano5Fabien De Poli6Pierre Leddet7Marilou Peillex8Sébastien Hess9Adrien Carmona10Charline Jimenez11Joe Heger12Antje Reydel13Patrick Ohlmann14Laurence Jesel15Olivier Morel16Pôle d'Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire Université de Strasbourg BP 426 Strasbourg 67091 FrancePôle d'Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire Université de Strasbourg BP 426 Strasbourg 67091 FrancePôle d'Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire Université de Strasbourg BP 426 Strasbourg 67091 FrancePôle d'Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire Université de Strasbourg BP 426 Strasbourg 67091 FrancePole d'activité cardiovasculaire Centre Hospitalier de Haguenau Haguenau FrancePole d'activité cardiovasculaire Hôpitaux Civils de Colmar Colmar FrancePole d'activité cardiovasculaire Centre Hospitalier de Haguenau Haguenau FrancePole d'activité cardiovasculaire Centre Hospitalier de Haguenau Haguenau FrancePôle d'Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire Université de Strasbourg BP 426 Strasbourg 67091 FrancePôle d'Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire Université de Strasbourg BP 426 Strasbourg 67091 FrancePôle d'Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire Université de Strasbourg BP 426 Strasbourg 67091 FrancePôle d'Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire Université de Strasbourg BP 426 Strasbourg 67091 FrancePôle d'Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire Université de Strasbourg BP 426 Strasbourg 67091 FrancePôle d'Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire Université de Strasbourg BP 426 Strasbourg 67091 FrancePôle d'Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire Université de Strasbourg BP 426 Strasbourg 67091 FrancePôle d'Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire Université de Strasbourg BP 426 Strasbourg 67091 FrancePôle d'Activité Médico‐Chirurgicale Cardio‐Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire Université de Strasbourg BP 426 Strasbourg 67091 FranceAbstract Aims Recent insights have emphasized the importance of myocardial and systemic inflammation in Takotsubo syndrome (TTS). In a large registry of unselected patients, we sought to evaluate whether residual high inflammatory response (RHIR) could impact cardiovascular outcome after TTS. Methods and results Patients with TTS were retrospectively included between 2008 and 2018 in three general hospitals. Three hundred eighty‐five patients with TTS were split into three subgroups, according to tertiles of C‐reactive protein (CRP) levels at discharge (CRP <5.2 mg/L, CRP range 5.2 to 19 mg/L, and CRP >19 mg/L). The primary endpoint was the impact of RHIR, defined as CRP >19 mg/L at discharge, on cardiac death or hospitalization for heart failure. Follow up was obtained in 382 patients (99%) after a median of 747 days. RHIR patients were more likely to have a history of cancer or a physical trigger. Left ventricular ejection fraction (LVEF) at admission and at discharge were comparable between groups. By contrast, RHIR was associated with lower LVEF at follow up (61.7% vs. 60.7% vs. 57.9%; P = 0.004) and increased cardiac late mortality (0% vs. 0% vs. 10%; P = 0.001). By multivariate Cox regression analysis, RHIR was an independent predictor of cardiac death or hospitalization for heart failure (hazard ratio: 1.87; 95% confidence interval: 1.08 to 3.25; P = 0.025). Conclusions Residual high inflammatory response was associated with impaired LVEF at follow up and was evidenced as an independent factor of cardiovascular events. All together, these findings underline RHIR patients as a high‐risk subgroup, to target in future clinical trials with specific therapies to attenuate RHIR.https://doi.org/10.1002/ehf2.12945Takotsubo syndromeResidual high inflammatory responseSystemic inflammatory response syndromePredictive factorLate cardiac deathLate cardiovascular outcome |