Clinical Characteristics and Outcomes of Patients With Takotsubo Syndrome Complicated With Acute Mitral Regurgitation

Acute mitral regurgitation (MR) is a serious complication of takotsubo syndrome (TTS). However, its incidence and prognostic implications are still poorly investigated.

This study aimed to assess the clinical characteristics, short- and long-term outcomes of patients with TTS complicated by acute, reversible, moderate or severe MR.

The study included TTS patients from the Takotsubo Italian Network multicenter registry. The primary outcome was the composite of in-hospital acute heart failure, cardiogenic shock, and mortality. Secondary outcomes included mortality and the recurrence of TTS at the longest available follow-up. The propensity score weighting technique was performed to account for potential confounders between patients with and without acute moderate or severe MR.

The study included 1,025 patients (mean age 70 ± 11 years, 91.6% females); of them, 186 (18.2%) showed acute moderate or severe MR. Logistic regression analysis showed a significantly higher risk for the primary outcome (adjusted OR: 2.29; 95% CI: 1.83-2.88), acute heart failure (adjusted OR: 2.17; 95% CI: 1.70-2.77), and cardiogenic shock (adjusted OR: 2.46; 95% CI: 1.69-3.59) in patients with acute MR compared to those without. Also, the coexistence of left ventricular outflow tract obstruction with acute MR further increased the risk for the primary outcome (adjusted OR: 5.26; 95% CI: 3.22-8.59). At long-term follow-up (median 29 months), patients who developed acute MR during hospitalization showed a significantly higher risk of mortality (adjusted HR: 1.82; 95% CI: 1.21-2.74).

In this real-world study, acute MR was associated with a significantly higher risk of adverse events during hospitalization and long-term mortality. Early echocardiographic detection of acute MR can support prognostic stratification and management of TTS patients.