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Article Dans Une Revue ESC Heart Failure Année : 2021

Impact of residual inflammation on myocardial recovery and cardiovascular outcome in Takotsubo patients

Charlotte Dagrenat
  • Fonction : Auteur
Stephane Greciano
  • Fonction : Auteur
Fabien de Poli
  • Fonction : Auteur
Pierre Leddet
  • Fonction : Auteur

Résumé

AIMS: Recent insights have emphasized the importance of myocardial and systemic inflammation in Takotsubo syndrome (TTS). In a large registry of unselected patients, we sought to evaluate whether residual high inflammatory response (RHIR) could impact cardiovascular outcome after TTS. METHODS AND RESULTS: Patients with TTS were retrospectively included between 2008 and 2018 in three general hospitals. Three hundred eighty-five patients with TTS were split into three subgroups, according to tertiles of C-reactive protein (CRP) levels at discharge (CRP <5.2 mg/L, CRP range 5.2 to 19 mg/L, and CRP >19 mg/L). The primary endpoint was the impact of RHIR, defined as CRP >19 mg/L at discharge, on cardiac death or hospitalization for heart failure. Follow up was obtained in 382 patients (99%) after a median of 747 days. RHIR patients were more likely to have a history of cancer or a physical trigger. Left ventricular ejection fraction (LVEF) at admission and at discharge were comparable between groups. By contrast, RHIR was associated with lower LVEF at follow up (61.7% vs. 60.7% vs. 57.9%; P = 0.004) and increased cardiac late mortality (0% vs. 0% vs. 10%; P = 0.001). By multivariate Cox regression analysis, RHIR was an independent predictor of cardiac death or hospitalization for heart failure (hazard ratio: 1.87; 95% confidence interval: 1.08 to 3.25; P = 0.025). CONCLUSIONS: Residual high inflammatory response was associated with impaired LVEF at follow up and was evidenced as an independent factor of cardiovascular events. All together, these findings underline RHIR patients as a high-risk subgroup, to target in future clinical trials with specific therapies to attenuate RHIR.
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Dates et versions

hal-03935570 , version 1 (11-01-2023)

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Lucie Lachmet-Thébaud, Benjamin Marchandot, Kensuke Matsushita, Chisato Sato, Charlotte Dagrenat, et al.. Impact of residual inflammation on myocardial recovery and cardiovascular outcome in Takotsubo patients. ESC Heart Failure, 2021, 8 (1), pp.259-269. ⟨10.1002/ehf2.12945⟩. ⟨hal-03935570⟩

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