Long-term prognosis in patients suffering from myocardial infarction with non-obstructive coronary arteries, ST-segment elevation myocardial infarction, infective myocarditis and tako-tsubo cardiomyopathy – all-cause mortality comparison

IntroductionMyocardial infarction with non-obstructive coronary arteries (MINOCA), tako-tsubo cardiomyopathy (TTC), infective myocarditis (IM) and acute ST-segment elevation myocardial infarction (STEMI) of anterior wall being a heterogeneous group, may occur in very similar clinical presentations. In this study, it was aimed to compare the prognosis and identify predictors of major adverse cardiac and cerebrovascular events (MACCE) and all-cause mortality in these groups of patients.Material and methodsAt 2 Polish Academic Cardiology Centres among 596 patients, we compared clinical characteristics and outcomes in 4 groups: MINOCA (318, 53.3%), TTC (31, 5.2%), IM (22, 3.7%) and STEMI (225, 37.7%). MACCE were defined as myocardial infarction (MI), revascularisation (either percutaneous or surgical), all-cause death and stroke/transient ischemic attacks. Survival curves were presented using Kaplan-Meier estimator and compared using log-rank test.ResultsKaplan-Meier survival analysis demonstrated that in the 3-year follow-up period, patients with anterior wall STEMI were at the highest risk of MACCE (p < 0.001). During the follow-up period, the greatest mortality rate was observed in the TTC group, however, this was without statistical significance. Multivariable regression analysis showed that long-term mortality was significantly related to age (p < 0.001), creatinine level (p < 0.001), platelet count (p < 0.001), white blood cells (p < 0.001) and hyperlipidaemia (p = 0.001).ConclusionsDuring the 3 years of follow-up, anterior wall STEMI had significantly poorer prognosis in terms of MACCE when compared to the TTC, IM and MINOCA groups. TTC was related to the greatest all-cause mortality, however, without statistical significance.

Evaluation of non-invasive myocardial work in tako-tsubo cardiomyopathy

Funding Acknowledgements Type of funding sources: None. Background Tako-tsubo cardiomyopathy (TTC) is characterized by the presence of transient left ventricular (LV) wall motion abnormalities (WMA). However, whether systolic performance fully recover is unclear. Non-invasive myocardial work (MW) is a new index of global and regional myocardial performance which has never been described in this setting. Objective: to assess global and regional MW in typical TTC (apical variant). Methods: fifty patients with typical TTC (mean age, 77 ± 10 years, 47 women) were prospectively enrolled and underwent a transthoracic Doppler echocardiography within 24 hours of admission and a median of 32 days at follow-up (FU). MW is derived from the non-invasive strain-pressure loop obtained from the 2D strain data, integrating in its calculation the non-invasive brachial arterial pressure. Constructive MW (CMW), MW index (MWI), MW efficiency (MWE), and wasted work (WW) were measured. Hospital complications (HC) were defined as a composite of heart failure, right ventricular extension, and LV apical thrombus. A control group of 24 patients matched for age and sex without overt cardiovascular disease served as a comparative group. Results: In the TTC group, global and regional MW improved significantly between the two examinations (global, regional apical and medial CMW, MWI, MWE, WW, and regional basal CMW, and MWI, all p &lt; 0.01). The acute apical –basal gradient of MW inverted at FU. In TTC, global CMW and MWI were significantly correlated to acute LV systolic function parameters and their change, and were significantly impaired in patients with HC (n = 13) (all, p &lt; 0.01). At FU, despite total recovery of WMA, global and regional MW was significantly reduced in TTC by comparison to the control group (p &lt; 0.01 for all components), although hemodynamics, LV ejection fraction, and 2D global longitudinal strain were similar (all, p = NS). Conclusion: Global and regional myocardial performance is transiently impaired in typical TTC and significantly associated to HC. And despite total recovery of WMA, subtle dysfunction of myocardial performance persist at FU.

Differences in the clinical characteristics and long-term outcome of peripartum tako-tsubo cardiomyopathy and peripartum cardiomyopathy

Background Some peripartum-associated cardiomyopathy patients present similarly to those of tako-tsubo cardiomyopathy (TCM), little is known about the clinical course of peripartum TCM. Purpose To know clinicial characteristics and outcomes of peripartum TCM, in comparison with peripartum cardiomyopathy (PPCM) Methods and results Of 31 pregnancy-associated cardiomyopathy patients in a tertiary hospital, 10 cases of peripartum TCM and 21 cases of PPCM were found. Maternal near-missed death was significantly more common in the peripartum TCM group than in the PPCM group (100.0% vs. 76.2%, p=0.030). Complete recovery was observed with all peripartum TCM cases, while 23.8% of the PPCM cases had residual left ventricle (LV) dysfunction. LV ejection fraction greater than 30% on the initial echocardiogram independently predicted early echocardiographic recovery of left ventricular systolic function (odds ratio 331.33, 95% confidence interval 3.87–28402.60, p=0.011). There was no difference between the two groups in terms of the rate of adverse clinical events at 3 years of follow-up (PPCM group: 26.3% [5/19] vs. TCM group: 33.3% [3/9], p=0.750). Conclusions One-third of pregnancy-associated cardiomyopathy patients had peripartum TCM. With contemporary supportive care, both PPCM and peripartum TCM patients had a low mortality rate and excellent long-term outcomes. Kaplan-Meier survival curves for death, Funding Acknowledgement Type of funding source: None

Ascending aortic aneurysm repair in the setting of Tako-tsubo cardiomyopathy

Tako-tsubo cardiomyopathy (TC) is characterized by acute but transient ventricular dysfunction without obstructive coronary artery disease, generally precipitated by emotional and physical triggers. We describe this syndrome in a 76-year-old woman who was admitted with thoracic pain secondary to TC as shown by echocardiographic assessment, with a concurrent diagnosis of giant ascending aortic aneurism. Surgical intervention was delayed to allow ventricular recovery and then to perform ascending aorta replacement. An individualized perioperative approach was applied to avoid a possible TC recurrence with an uneventful postoperative course.