Electrocardiographic predictors of adverse in-hospital outcomes in the Takotsubo syndrome

Background: Takotsubo syndrome (TS) is a life-threatening acute heart failure syndrome. However, little is known about risk factors for worse outcomes in TS and no high-risk ECG criteria have been defined. We sought to identify ECG predictors of life-threatening in-hospital complications in TS. Method and result: Using the nationwide Swedish Angiography and Angioplasty Registry (SCAAR) we obtained data on all consecutive patients undergoing coronary angiography at Sahlgrenska University Hospital between June 2008 and February 2019. For all patients with TS we conducted in-depth chart reviews to confirm the TS diagnosis. For those with confirmed TS we then evaluated all ECGs obtained during the index hospitalization. The primary endpoint was the occurrence of in-hospital major adverse cardiac event (MACE), definedas the composite of death, ventricular tachycardia or fibrillation (VT/VF), or atrioventricular block >= 2 or asystole >> 10 s. We identified 215 patients with TS (mean age 69 +/- 13 years; 93% women). MACE occurred in 34 patients (16%), of whom 20 had VT/VF (9,3%). Patients with MACE were less likely than those without MACE to have sinus rhythm(85% versus 96%, p=0.025) or T-wave inversion (29% versus 51%, p=0.025). After propensity score adjustment T-wave inversion was independently associated with lower MACE risk (adjusted odds ratio [AdjOR] 0.28, 95% confidence interval [CI] 0.10-0.76, p=0.012) and VT/VF (AdjOR 0.24, 95% CI 0.06-0.94, p=0.041). Conclusion: T-wave inversion is common in TS and is associated with lower risk of MACE, driven by a lower risk of VT/VF. (C) 2019 Elsevier B.V. All rights reserved.