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Left Ventricular Ballooning Patterns in Recurrent Takotsubo Cardiomyopathy: A Systematic Review and Meta-analysis of
Ravi Korabathina1,2, Jamie Porcadas3, Kevin E Kip4
1Department of Cardiovascular Medicine, Bayfront Health, St. Petersburg, Florida.
Insights
Recurrent takotsubo cardiomyopathy (TTC) outcomes differ by left ventricular ballooning pattern. Atypical patterns are linked to fewer severe adverse events and better survival compared to typical apical patterns in recurrent TTC patients.
Area of Science:
- Cardiology
- Internal Medicine
Background:
- Recurrent takotsubo cardiomyopathy (TTC) and its clinical impact remain incompletely understood.
- The influence of left ventricular (LV) ballooning patterns on recurrent TTC outcomes requires further investigation.
Purpose of the Study:
- To evaluate clinical profiles and outcomes of patients with recurrent TTC.
- To compare outcomes based on left ventricular ballooning patterns during recurrence.
Main Methods:
- Systematic literature search identifying 101 cases of recurrent TTC from 84 articles.
- Classification of cases into typical (apical ballooning only) and atypical (midventricular or basal ballooning) groups.
- Comparison of demographic characteristics, triggers, treatments, and clinical outcomes between the two groups.
Main Results:
- The atypical group (n=41) experienced significantly fewer severe adverse events (cardiogenic shock, cardiac arrest) compared to the typical group (n=60) (adjusted odds ratio=0.37).
- Survival to hospital discharge was higher in the atypical group (96%) versus the typical group (88.3%).
- Demographics, triggers, medications, ECG changes, and recovery times were similar between groups.
Conclusions:
- Left ventricular ballooning patterns significantly influence clinical outcomes in recurrent TTC.
- Patients with atypical LV ballooning patterns exhibit more favorable outcomes, including reduced severe adverse events and improved survival.
Abstract:
Recurrent takotsubo cardiomyopathy (TTC) and the clinical profiles and outcomes of patients have not been fully evaluated, nor has the effect of left ventricular ballooning pattern. After searching the medical literature for reports of patients with recurrent TTC, we identified 84 articles with 101 case descriptions. We divided the cases into those with only apical left ventricular ballooning patterns at recurrence (typical, n=60), and those with at least one midventricular or basal ballooning pattern (atypical, n=41). We then compared their clinical profiles and outcomes. The groups were similar in terms of baseline demographic characteristics, presence and types of triggers, use of heart failure medications at TTC recurrence, electrocardiographic changes at presentation, initial left ventricular ejection fractions, timespans between recurrent TTC episodes, and recovery times after each event. However, patients in the atypical group had significantly fewer severe adverse events (cardiogenic shock and cardiac arrest) than did those in the typical group, with an estimated 63% lower odds (adjusted odds ratio=0.37; 95% CI, 0.14-0.97; P=0.039). Survival to hospital discharge was statistically similar but lower in the typical group (n=53; 88.3%) than in the atypical group (n=24; 96%). Our results suggest that left ventricular ballooning patterns influence clinical outcomes, and that outcomes are more favorable in patients with recurrent TTC who have atypical left ventricular ballooning patterns.
