Predictive Value of QRS Duration at Admission for In-Hospital Clinical Outcome of Takotsubo Cardiomyopathy.

Abstract

BACKGROUND:

Prolonged QRS duration (pQRSd) on electrocardiogram (ECG) is a strong predictor of poor outcome in heart failure, myocardial infarction, and myocarditis, but it is unclear whether pQRSd also predicts poor outcomes of takotsubo cardiomyopathy (TC).Methods and Results:Between 1 January 2010 and 31 December 2012, we retrospectively enrolled 299 patients with TC (mean age, 73.5±11.7 years; 21.4% male) from the Tokyo CCU Network database, which consists of 71 cardiovascular centers in the metropolitan area. In-hospital clinical outcomes were compared between patients with pQRSd on admission ECG (QRS ≥120 ms; n=34) and those with normal QRS duration (<120 ms; n=265). The in-hospital mortality rate for pQRSd was significantly higher than that for normal QRS duration (23.5% vs. 3.8%, P<0.001). Similarly, prevalence of ventilator use (38.2% vs. 11.4%, P<0.001), ventricular tachycardia or fibrillation (14.7% vs. 1.5%, P<0.001), and circulatory failure requiring catecholamine or cardiopulmonary supportive devices (41.2% vs. 14.0%, P<0.001) was significantly higher in the pQRSd group. On multivariate logistic regression analysis, pQRSd was an independent predictor for both in-hospital mortality (OR, 5.06; 95% CI: 1.79-14.30, P=0.002) and cardiac death (OR, 7.34; 95% CI: 1.33-40.51, P=0.02).

CONCLUSIONS:

TC with pQRSd is associated with poor in-hospital clinical outcome. Aggressive intervention may be required to prevent severe complications in these patients.

• Authors: Tetsuo Yamaguchi, Tsutomu Yoshikawa, Toshiaki Isogai, Takamichi Miyamoto, Yuichiro Maekawa, Tetsuro Ueda, Konomi Sakata, Tsutomu Murakami, Takeshi Yamamoto, Ken Nagao, Morimasa Takayama
• Journal: Circulation journal : official journal of the Japanese Circulation Society (Circ J) Vol. 81 Issue 1 Pg. 62-68 (Dec 22 2016) ISSN: 1347-4820 [Electronic] Japan
• PMID: 27916778 (Publication Type: Clinical Trial, Journal Article, Multicenter Study)

Topics

• Aged
• Aged, 80 and over
• Electrocardiography (methods)
• Female
• Hospital Mortality
• Humans
• Male
• Middle Aged
• Predictive Value of Tests
• Prospective Studies
• Takotsubo Cardiomyopathy (mortality, physiopathology)