https://doi.org/10.4081/monaldi.2023.2834
QT interval prolongation in Takotsubo syndrome: a frightening feature with no major prognostic impact
Submitted: October 26, 2023
Accepted: December 4, 2023
Published: December 6, 2023
Accepted: December 4, 2023
Abstract Views: 737
PDF_EARLY VIEW: 307
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All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Despite the frequent and often severe repolarization abnormalities seen in Takotsubo syndrome (TTS), the underlying mechanism of life-threatening arrhythmias is incompletely understood, and the risk remains uncertain. TTS is considered a potential cause of acquired long QT syndrome; however, there is no robust evidence that QT prolongation has a major prognostic impact on these patients’ outcomes. Our aim was to assess the prevalence and clinical implications of acquired long QT during TTS events and compare in-hospital and long-term outcomes between patients with and without corrected QT interval (QTc) prolongation. This is a retrospective cohort study that included 113 patients admitted to our tertiary care hospital with a diagnosis of TTS. The cohort was divided into two groups: a long QTc group (QTc≥460 milliseconds in any electrocardiogram at admission or during hospitalization) and a normal QTc group. Baseline characteristics, occurrences during hospitalization, and outcome data were obtained from the revision of medical registries and hospital visits. Of the 113 patients, 107 (94.7%) were female. The mean age was 67.6±11.7 years. QTc prolongation was found in 38%. Demographic characteristics, relevant chronic medication, prevalence of cardiovascular risk factors, and other comorbidities were similar between the groups, except for history of atrial fibrillation, which was more common in the long QTc group. Syncope was more prevalent in the long QTc group. In-hospital complications were not statistically different between patients with long and normal QTc (48.8% versus 44.2%, p=0.637), including ventricular arrhythmias and complete atrioventricular block (both 4.7% versus 1.4%, p=0.556). In-hospital mortality was 0.9%, corresponding to one patient in the long QTc group. The mean follow-up time was 4.8±3.8 years. 5-year all-cause mortality and the occurrence of the composite endpoint of major adverse cardiac and cerebrovascular events did not differ between the groups (p=0.511 and p=0.538, respectively). Our study found no association between prolonged QTc interval during TTS events and adverse prognosis, since in-hospital and long-term outcomes were similar between the groups. Our findings suggest that, although QT prolongation is usually a frightening feature on ECG, this repolarization abnormality during the acute phase has no major prognostic implications in the TTS population.
Sato TH, Uchida T, Dote KMI. Tako-tsubo-like left ventricular dysfunction due to multivessel coronary spasm. In: Kodama K, Haze K, Hori M, eds. Clinical aspect of myocardial injury: from ischemia to heart failure. Tokyo: Kagakuhyoronsha Publishing Co; 1990. pp 56-64.
Lyon AR, Bossone E, Schneider B, et al. Current state of knowledge on Takotsubo syndrome: a position statement from the taskforce on Takotsubo syndrome of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail 2016;18:8-27.
DOI: https://doi.org/10.1002/ejhf.424
Ghadri JR, Wittstein IS, Prasad A, et al. International expert consensus document on Takotsubo syndrome (part i): clinical characteristics, diagnostic criteria, and pathophysiology. Eur Heart J 2018;39:2032-46.
DOI: https://doi.org/10.1093/eurheartj/ehy076
Ghadri JR, Kato K, Cammann VL, et al. Long-term prognosis of patients with Takotsubo syndrome. J Am Coll Cardiol 2018;72:874-82.
DOI: https://doi.org/10.1016/j.jacc.2018.06.016
Templin C, Ghadri JR, Diekmann J, et al. clinical features and outcomes of Takotsubo (stress) cardiomyopathy. N Engl J Med 2015;373:929-38.
DOI: https://doi.org/10.1056/NEJMoa1406761
Medina de Chazal H, Del Buono MG, Keyser-Marcus L, et al. Stress cardiomyopathy diagnosis and treatment: JACC state-of-the-art review. J Am Coll Cardiol 2018;72:1955-71.
DOI: https://doi.org/10.1016/j.jacc.2018.07.072
Behr ER, Mahida S. Takotsubo cardiomyopathy and the long-QT syndrome: an insult to repolarization reserve. Europace 2009;11:697-700.
DOI: https://doi.org/10.1093/europace/eup081
Ghadri JR, Wittstein IS, Prasad A, et al. International expert consensus document on Takotsubo syndrome (part ii): diagnostic workup, outcome, and management. Eur Heart J 2018;39:2047-62.
DOI: https://doi.org/10.1093/eurheartj/ehy077
Del Buono MG, Damonte JI, Moroni F, et al. QT Prolongation and in-hospital ventricular arrhythmic complications in patients with apical ballooning Takotsubo syndrome. JACC Clin Electrophysiol 2022;8:1500-10.
DOI: https://doi.org/10.1016/j.jacep.2022.08.010
Jesel L, Berthon C, Messas N, et al. Ventricular arrhythmias and sudden cardiac arrest in Takotsubo cardiomyopathy: incidence, predictive factors, and clinical implications. Heart Rhythm 2018;15:1171-8.
DOI: https://doi.org/10.1016/j.hrthm.2018.04.002
Koh Y, Voskoboinik A, Neil C. Arrhythmias and their electrophysiological mechanisms in Takotsubo syndrome: a narrative review. Heart Lung Circ 2022;31:1075-84.
DOI: https://doi.org/10.1016/j.hlc.2022.03.010
Laurence G, Vasiliu A, Blommaert D, et al. Typical dynamic electrocardiographic changes in Takotsubo syndrome. Acta Cardiol 2022;77:146-52.
DOI: https://doi.org/10.1080/00015385.2021.1890924
Stiermaier T, Eitel C, Denef S, et al. Prevalence and clinical significance of life-threatening arrhythmias in Takotsubo cardiomyopathy. J Am Coll Cardiol 2015;65:2148-50.
DOI: https://doi.org/10.1016/j.jacc.2015.02.062
Pena Escobar JA, Aung M, Amin S, et al. Pathogenesis of ventricular arrhythmias and its effect on long-term prognosis in patients with Takotsubo cardiomyopathy. Cureus 2020;12:e11171.
DOI: https://doi.org/10.7759/cureus.11171
Omerovic E, Citro R, Bossone E, et al. Pathophysiology of Takotsubo syndrome - a joint scientific statement from the Heart Failure Association Takotsubo syndrome study group and myocardial function working group of the European Society of Cardiology - part 1: overview and the central role for catecholamines and sympathetic nervous system. Eur J Heart Fail 2022;24:257-73.
DOI: https://doi.org/10.1002/ejhf.2413
Omerovic E, Citro R, Bossone E, et al. Pathophysiology of Takotsubo syndrome - a joint scientific statement from the Heart Failure Association Takotsubo syndrome study group and myocardial function working group of the European Society of Cardiology - part 2: vascular pathophysiology, gender and sex hormones, genetics, chronic cardiovascular problems and clinical implications. Eur J Heart Fail 2022;24:274-86.
DOI: https://doi.org/10.1002/ejhf.2390
Singh T, Khan H, Gamble DT, et al. Takotsubo syndrome: pathophysiology, emerging concepts, and clinical implications. Circulation 2022;145:1002-19.
DOI: https://doi.org/10.1161/CIRCULATIONAHA.121.055854
Lyon AR, Citro R, Schneider B, et al. Pathophysiology of Takotsubo syndrome: JACC state-of-the-art review. J Am Coll Cardiol. 2021;77:902-21.
DOI: https://doi.org/10.1016/j.jacc.2020.10.060
Martín de Miguel I, Núñez-Gil IJ, Pérez-Castellanos A, et al. Electrocardiographic characteristics and associated outcomes in patients with Takotsubo syndrome. Insights from the RETAKO registry. Curr Probl Cardiol 2021;46:100841.
DOI: https://doi.org/10.1016/j.cpcardiol.2021.100841
Ghadri JR, Cammann VL, Jurisic S, et al. A novel clinical score (InterTAK Diagnostic Score) to differentiate takotsubo syndrome from acute coronary syndrome: results from the International Takotsubo Registry. Eur J Heart Fail 2017;19:1036-42.
DOI: https://doi.org/10.1002/ejhf.683
Braschi A, Frasheri A, Lombardo RM, et al. Association between Tpeak-Tend/QT and major adverse cardiovascular events in patients with Takotsubo syndrome. Acta Cardiol 2021;76:732-8.
DOI: https://doi.org/10.1080/00015385.2020.1776012
Hohneck A, El-Battrawy I, Lang S, et al. Protective effect of acquired long QT syndrome in Takotsubo syndrome. Intern Med J 2019;49:770-6.
DOI: https://doi.org/10.1111/imj.14169
Imran TF, Rahman I, Dikdan S, et al. QT prolongation and clinical outcomes in patients with Takotsubo cardiomyopathy. Pacing Clin Electrophysiol 2016;39:607-11.
DOI: https://doi.org/10.1111/pace.12864
Madias C, Fitzgibbons TP, Alsheikh-Ali AA, et al. Acquired long QT syndrome from stress cardiomyopathy is associated with ventricular arrhythmias and torsades de pointes. Heart Rhythm 2011;8:555-61.
DOI: https://doi.org/10.1016/j.hrthm.2010.12.012
Santoro F, Brunetti ND, Tarantino N, et al. Dynamic changes of QTc interval and prognostic significance in takotsubo (stress) cardiomyopathy. Clin Cardiol 2017;40:1116-22.
DOI: https://doi.org/10.1002/clc.22798
Migliore F, Zorzi A, Peruzza F, et al. Incidence and management of life-threatening arrhythmias in Takotsubo syndrome. Int J Cardiol 2013;166:261-3.
DOI: https://doi.org/10.1016/j.ijcard.2012.09.107
Malanchini G, Del Corral MP, De Filippo P, et al. Cardiac arrhythmias and In-hospital mortality amongst patients with takotsubo cardiomyopathy: a retrospective study in an Italian population. Int J Cardiol Heart Vasc 2020;31:100608.
DOI: https://doi.org/10.1016/j.ijcha.2020.100608
El-Battrawy I, Santoro F, Stiermaier T, et al. Prevalence, management, and outcome of adverse rhythm disorders in takotsubo syndrome: insights from the international multicenter GEIST registry. Heart Fail Rev 2020;25:505-11.
DOI: https://doi.org/10.1007/s10741-019-09856-4
Gopalakrishnan M, Hassan A, Villines D, et al. Predictors of short- and long-term outcomes of Takotsubo cardiomyopathy. Am J Cardiol 2015;116:1586-90.
DOI: https://doi.org/10.1016/j.amjcard.2015.08.024
Stiermaier T, Rommel KP, Eitel C, et al. Management of arrhythmias in patients with Takotsubo cardiomyopathy: is the implantation of permanent devices necessary?. Heart Rhythm 2016;13:1979-86.
DOI: https://doi.org/10.1016/j.hrthm.2016.06.013
Ethics Approval
The study was approved by the Ethics Committee of “Centro Hospitalar Universitário de São João / Faculdade de Medicina da Universidade do Porto” on December 13, 2022 (reference number 287/22).How to Cite
Pinho, Ana Isabel, Cátia Oliveira, Luís Daniel Santos, Catarina Marques, André Cabrita, Paula Dias, Gonçalo Pestana, Carla Sousa, and Rui André Rodrigues. 2023. “QT Interval Prolongation in Takotsubo Syndrome: A Frightening Feature With No Major Prognostic Impact”. Monaldi Archives for Chest Disease, December. https://doi.org/10.4081/monaldi.2023.2834.
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