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Evaluation of therapy management and outcome in Takotsubo syndrome

Abanador-Kamper, Nadine ; Kamper, Lars ; Wolfertz, Judith ; Pomjanski, Witali ; Wolf-Pütz, Anamaria ; Seyfarth, Melchior

BMC cardiovascular disorders, 2017-08, Vol.17 (1), p.225-225, Article 225 [Periódico revisado por pares]

England: BioMed Central Ltd

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Título:
Evaluation of therapy management and outcome in Takotsubo syndrome
Autor: Abanador-Kamper, Nadine ; Kamper, Lars ; Wolfertz, Judith ; Pomjanski, Witali ; Wolf-Pütz, Anamaria ; Seyfarth, Melchior
Assuntos: Acute coronary syndrome ; Acute coronary syndromes ; Adrenergic receptors ; Aged ; Aged, 80 and over ; Antiplatelet therapy ; Antithrombotic management ; Balloon treatment ; Bleeding ; Cardiomyopathy ; Cardiovascular Agents - adverse effects ; Cardiovascular Agents - therapeutic use ; Cardiovascular disease ; Cardiovascular magnetic resonance imaging ; Care and treatment ; Complications and side effects ; Coronary vessels ; Diagnosis ; Dosage and administration ; Drug Therapy, Combination ; Edema ; Edema, Cardiac - diagnosis ; Edema, Cardiac - drug therapy ; Edema, Cardiac - physiopathology ; Electrocardiography ; Female ; Fibrinolysis ; Gadolinium ; Heart attacks ; Heart diseases ; Heart failure ; Hemorrhage - chemically induced ; Humans ; Kaplan-Meier Estimate ; Magnetic Resonance Imaging ; Male ; Medical Records ; Middle Aged ; Mortality ; Myocardial diseases ; NMR ; Nuclear magnetic resonance ; Patient Discharge ; Patients ; Physiological aspects ; Platelet aggregation inhibitors ; Prognosis ; Recovery of Function ; Retrospective Studies ; Risk Factors ; Stroke Volume - drug effects ; Takotsubo cardiomyopathy ; Takotsubo Cardiomyopathy - diagnosis ; Takotsubo Cardiomyopathy - drug therapy ; Takotsubo Cardiomyopathy - mortality ; Takotsubo Cardiomyopathy - physiopathology ; Time Factors ; Treatment Outcome ; Ventricle ; Ventricular Function, Left - drug effects
É parte de: BMC cardiovascular disorders, 2017-08, Vol.17 (1), p.225-225, Article 225
Notas: ObjectType-Article-2
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Descrição: To date there is no validated evidence for standardized treatment of patients with Takotsubo syndrome (TTS). Medication therapy after final TTS diagnosis remains unclear. Previous data on patient outcome is ambivalent. Aim of this study was to evaluate medication therapy in TTS and to analyze patient outcome. Within an observational retrospective cohort study we analyzed our medical records and included 72 patients with TTS that underwent cardiovascular magnetic resonance imaging (CMR) after a median of 2 days interquartile range (IQR 1-3.5). We investigated medication therapy at discharge. Medication implementation and major adverse clinical events (MACE) were prospectively evaluated after a median follow-up of 24 months (IQR 6-43). Left ventricular function, myocardial oedema and late gadolinium enhancement were analyzed in a CMR follow-up if available. Antithrombotic therapy was recommended in 69 (96%) patients including different combinations. Antiplatelet monotherapy was prescribed in 28 (39%) patients. Dual antiplatelet therapy was recommended in 29 (40%) patients. Length of therapy duration varied from one to twelve months. Only in one case oral anticoagulation was prescribed due to apical ballooning with a left ventricular ejection fraction <30%. In all other cases oral anticoagulation was recommended due to other indications. ß-adrenoceptor antagonists and ACE inhibitors were recommended in 63 (88%), mineralocorticoid receptor antagonists were prescribed in 31 (43%) patients. After a median of 2 months (IQR 1.3-2.9) left ventricular function significantly recovered (49.1% ± 10.1 vs. 64.1% ± 5.7, P < 0.001) and myocardial oedema significantly decreased (13.5 ± 11.3 vs. 0.6% ± 2.4, P = <0.001) in the CMR follow-up. The 30-day mortality was 1%. MACE rate after 24 months was 12%. Although therapy guidelines for TTS currently do not exist, we found that the majority of patients were treated with antithrombotic and heart failure therapy for up to twelve months. Left ventricular function and myocardial oedema recovered rapidly within the first two months. Outcome analysis showed a low bleeding rate and a high short-term survival. Therefore, TTS patients might benefit from antithrombotic and heart failure therapy at least for the first two months.
Editor: England: BioMed Central Ltd
Idioma: Inglês

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Evaluation of therapy management and outcome in Takotsubo syndrome

Abanador-Kamper, Nadine ; Kamper, Lars ; Wolfertz, Judith ; Pomjanski, Witali ; Wolf-Pütz, Anamaria ; Seyfarth, Melchior

England: BioMed Central Ltd

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