OUTCOMES IN TAKOTSUBO SYNDROME FOLLOWING LEFT VENTRICULAR EJECTION FRACTION IMPROVEMENT

Abstract

Background: Takotsubo Syndrome (TTS), a transient form of stress-induced cardiomyopathy, often presents with acute left ventricular systolic dysfunction.
Objectives: To evaluate long-term clinical outcomes in patients with Takotsubo Syndrome who demonstrated improvement in left ventricular ejection fraction (LVEF), and to identify predictors of adverse events during follow-up.
Methods: This retrospective observational study was conducted at NICVD and tabba hospital Karachi during Feb 2024 to July 2024.  A total of 78 patients were added to the study. Data were extracted from electronic health records using a standardized questionnaire. Baseline variables included patient demographics such as age, sex, and ethnicity; clinical presentation including type of stressor (emotional or physical), chest pain, electrocardiogram findings, and troponin levels; and imaging findings with particular attention to LVEF at admission, nadir, and follow-up.
Results: The mean age was 67.4 ± 11.2 years, and 78.2% of the cohort were female. Despite LVEF recovery, 26.9% of patients experienced MACE during follow-up. Heart failure hospitalizations (11.5%), new-onset arrhythmias (9.0%), and recurrent TTS (6.4%) were the most common adverse events. Independent predictors of MACE included diabetes mellitus (HR 2.34; 95% CI 1.01–5.42; p=0.047), baseline LVEF <35% (HR 2.89; 95% CI 1.15–7.23; p=0.024), and in-hospital arrhythmias (HR 3.12; 95% CI 1.19–8.14; p=0.019).
Conclusions: It is concluded that patients with Takotsubo Syndrome remain at significant risk for cardiovascular complications even after LVEF improvement. Risk factors such as diabetes, low initial LVEF, and arrhythmias during hospitalization should inform post-discharge care strategies.