Vasoactive-Inotropic Score in Takotsubo syndrome induced cardiogenic shock

Area of Science:

• Cardiology
• Critical Care Medicine
• Clinical Research

Background:

• Takotsubo syndrome (TTS) can lead to cardiogenic shock (CS), a life-threatening condition.
• The Vasoactive-Inotropic Score (VIS) is used to quantify the need for hemodynamic support in critically ill patients.
• Prognostic markers for TTS complicated by CS are crucial for risk stratification and management.

Purpose of the Study:

• To evaluate the prognostic significance of the Vasoactive-Inotropic Score (VIS) in patients experiencing Takotsubo syndrome (TTS) with concurrent cardiogenic shock (CS).
• To determine the association between VIS tertiles and short-term (30-day) and long-term (1-year) mortality in this patient population.

Main Methods:

• A retrospective cohort analysis was conducted using data from the RETAKO multicenter registry (2003-2022).
• 1591 patients with TTS were analyzed, with a focus on the 412 (26%) who developed CS.
• VIS was calculated based on maximum vasoactive and inotropic drug doses within 24 hours of CS diagnosis.

Main Results:

• Patients in the highest VIS tertile exhibited significantly higher 30-day (HR 8.80) and 1-year (HR 4.55) mortality compared to the lowest tertile.
• Higher VIS was associated with increased complications, including acute kidney injury, major bleeding, and need for mechanical circulatory support.
• In-hospital mortality rates increased progressively across VIS tertiles: 4% (low), 14% (middle), and 47% (high) (p < 0.001).

Conclusions:

• The Vasoactive-Inotropic Score (VIS) is a valuable prognostic tool for patients with Takotsubo syndrome (TTS) complicated by cardiogenic shock (CS).
• Elevated VIS is strongly associated with adverse short- and long-term outcomes, including increased mortality and complications.
• Further investigation into causal pathways and therapeutic optimization for high-VIS patients is warranted.