Silent left ventricular apical ballooning and Takotsubo cardiomyopathy in an Australian intensive care unit

• Main Authors: Alexandra C. Rowell, Wade G. Stedman, Pierre F. Janin, Naomi Diel, Michael R. Ward, Sharon M. Kay, Anthony Delaney, Gemma A. Figtree
• Format: Article
• Language: English
• Published: Wiley 2019-12-01
• Series: ESC Heart Failure
• Subjects: Intensive care; Takotsubo cardiomyopathy; Inotropes; Adrenergic; Echocardiography
• Online Access: https://doi.org/10.1002/ehf2.12517

Abstract Aims Recent reports have shown a high incidence of silent left ventricular apical ballooning (LVAB) in the intensive care unit (ICU) setting with potential implications for safe use of inotropes and vasopressors. We examined the incidence, predictors, and associated outcomes of LVAB in patients in a contemporary tertiary Australian ICU. Methods and results In a prospective cohort study, patients were screened within 24 h of admission to the ICU and enrolled if they were deemed critically unwell based on mechanical ventilation, administration of >5 mg/min of noradrenaline, or need for renal replacement therapy. Exclusion criteria were a primary diagnosis of Takotsubo cardiomyopathy, admission to ICU after cardiac surgery, or with acute myocardial infarction or heart failure. Echocardiography was performed, and the presence/absence of LVAB was documented. A total of 116 patients were enrolled of whom four had LVAB (3.5%, 95% confidence interval 0.9–8.6%). Female sex was the only baseline demographic or clinical characteristic associated with incident LVAB. Medical history, ICU admission indication, and choice of inotropes were not associated with increased risk. Patients with LVAB had no deaths and had similar lengths of ICU and hospital stay compared with patients with no LVAB. Conclusions The incidence of silent LVAB suggestive of TC was substantially lower in this study than recently reported in other international ICU settings. We did not observe a suggestion of worse outcomes. A larger, multi‐centre study, prospectively screening for LVAB may help understand any variation between centres and regions, with important implications for ICU management.