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Implications of Left Bundle Branch Block in Takotsubo Cardiomyopathy: Propensity Match Analysis from the National
Dipesh Ludhwani1, Mouyyad Rahaby2, Vasu Patel2
1Chicago Medical School, Rosalind Franklin University, Northwestern McHenry Hospital, 4309 West Medical Center Drive, McHenry, IL, 60050, USA. dipeshludhwani91@gmail.com.
Insights
Left bundle branch block (LBBB) in Takotsubo cardiomyopathy (TTC) patients is linked to higher risks of cardiogenic shock and arrhythmias. Identifying LBBB in TTC can help recognize high-risk individuals for timely intervention.
Area of Science:
- Cardiology
- Internal Medicine
- Medical Research
Background:
- Takotsubo cardiomyopathy (TTC), or stress cardiomyopathy, is a temporary heart dysfunction mimicking acute coronary syndromes.
- In-hospital complication rates are similar between TTC and myocardial infarction (MI).
- Left bundle branch block (LBBB) is a known mortality predictor in MI, but its impact on TTC outcomes is understudied.
Purpose of the Study:
- To investigate the association between LBBB and in-hospital outcomes in patients diagnosed with TTC.
- To compare the incidence of adverse events in TTC patients with and without LBBB.
Main Methods:
- Utilized the 2016 National Inpatient Sample (NIS) database for TTC admissions.
- Stratified patients based on the presence or absence of LBBB.
- Employed 1:10 propensity score matching and multivariate logistic regression to analyze outcomes.
Main Results:
- Among 7270 TTC admissions, 226 had LBBB. Propensity-matched analysis included 130 LBBB patients and 1275 non-LBBB patients.
- LBBB was associated with increased odds of cardiogenic shock (AOR=2.2), ventricular arrhythmia (AOR=1.99), acute congestive heart failure (AOR=1.49), and sudden cardiac arrest (AOR=3.37).
- No significant difference in all-cause in-hospital mortality was observed, though a trend towards worsening outcomes was noted.
Conclusions:
- The presence of LBBB in TTC patients identifies a population at higher risk for adverse events like shock and arrhythmias.
- Timely intervention for LBBB in TTC may prevent life-threatening complications.
- Further prospective studies are needed to establish causality and long-term outcomes.
Introduction:
Takotsubo cardiomyopathy (TTC), also called stress cardiomyopathy, is a transient reversible left ventricular dysfunction mimicking acute coronary syndrome (ACS). Studies have shown similar rates of in-hospital complications in TTC and myocardial infarction (MI). Left bundle branch block (LBBB) is associated with increased mortality in patients with MI; however, similar studies comparing outcomes of TTC in the presence of LBBB are lacking.
Methods:
The 2016 National Inpatient Sample (NIS) database was queried to identify all admissions with a primary discharge diagnosis of TTC. Diagnosis-specific codes were used to stratify patients based on the presence or absence of LBBB. Both population sets were paired using 1:10 propensity score matching. Multivariate logistic regression analysis was performed to compare various in-hospital outcomes among both groups.
Results:
Amongst 7270 admissions for TTC, 226 patients had concomitant LBBB. After performing 1:10 propensity matching, 130 patients with LBBB were compared to 1275 patients without LBBB. The presence of LBBB was associated with increased odds of cardiogenic shock (AOR = 2.2, 95% CI 1.21-3.99, p = 0.0097); ventricular arrhythmia (AOR 1.99, 95% CI 1.11-3.57, p = 0.02), acute congestive heart failure (AOR = 1.49, 95% CI 1.01-2.2, p = 0.04), and sudden cardiac arrest (AOR = 3.37, 95% CI 1.59-7.13, p = 0.0001). There was no statistical difference in all-cause in-hospital mortality, however a trend towards worsening was noted.
Conclusions:
The incidence of arrhythmia and shock in patients with TTC does not correlate with the extent of myocardium involvement. The presence of LBBB in such cases can help recognize at-risk populations, and with timely intervention, life-threatening complications can be avoided. Despite limitations of the dataset and inability to establish causality, prospective studies with longer follow-up are warranted.
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