Ethnic comparison in takotsubo syndrome: novel insights from the International Takotsubo Registry.

BACKGROUND: Ethnic disparities have been reported in cardiovascular disease. However, ethnic disparities in takotsubo syndrome (TTS) remain elusive. This study assessed differences in clinical characteristics between Japanese and European TTS patients and determined the impact of ethnicity on in-hospital outcomes. METHODS: TTS patients in Japan were enrolled from 10 hospitals and TTS patients in Europe were enrolled from 32 hospitals participating in the International Takotsubo Registry. Clinical characteristics and in-hospital outcomes were compared between Japanese and European patients. RESULTS: A total of 503 Japanese and 1670 European patients were included. Japanese patients were older (72.6 ± 11.4 years vs. 68.0 ± 12.0 years; p < 0.001) and more likely to be male (18.5 vs. 8.4%; p < 0.001) than European TTS patients. Physical triggering factors were more common (45.5 vs. 32.0%; p < 0.001), and emotional triggers less common (17.5 vs. 31.5%; p < 0.001), in Japanese patients than in European patients. Japanese patients were more likely to experience cardiogenic shock during the acute phase (15.5 vs. 9.0%; p < 0.001) and had a higher in-hospital mortality (8.2 vs. 3.2%; p < 0.001). However, ethnicity itself did not appear to have an impact on in-hospital mortality. Machine learning approach revealed that the presence of physical stressors was the most important prognostic factor in both Japanese and European TTS patients. CONCLUSION: Differences in clinical characteristics and in-hospital outcomes between Japanese and European TTS patients exist. Ethnicity does not impact the outcome in TTS patients. The worse in-hospital outcome in Japanese patients, is mainly driven by the higher prevalence of physical triggers. TRIAL REGISTRATION: URL: https://www.clinicaltrials.gov ; Unique Identifier: NCT01947621.

In vivo assessment of endothelial permeability of coronary lesions with variable degree of stenosis using an albumin-binding MR probe.

MR imaging with an albumin-binding probe enables the visualization of endothelial permeability and damage in the arterial system. The goal of this study was to compare signal enhancement of lesions with different grades of stenosis segments on molecular CMR in combination with the albumin-binding probe gadofosveset. This prospective clinical study included patients with symptoms suggestive of coronary artery disease (CAD). Patients underwent gadofosveset-enhanced cardiovascular magnetic resonance (CMR) imaging and x-ray angiography (QCA) within 24 h. CMR imaging was performed prior to and 24 h following the administration of gadofosveset. Contrast-to-noise ratios (CNRs) between segments with different grades of stenosis were compared. Overall, n = 203 segments of 26 patients were included. Lesions with more than > 70% stenosis demonstrated significantly higher CNRs compared to lesions < 70% (7.6 ± 8.3 vs. 2.5 ± 4.9; p < 0.001). Post-stenotic segments of lesions > 70% stenosis showed significant higher signal enhancement compared to segments located upstream of these lesions (7.3 ± 8.8 vs. 2.8 ± 2.2; p = 0.02). No difference in signal enhancement between segments proximal and distal of lesions with stenosis greater than 50% was measured (3.3 ± 2.8 vs. 2.4 ± 2.7; p = 0.18). ROC analysis for the detection of lesions ≥ 70% revealed an area under the curve of 0.774 (95% CI 0.681-0.866). This study suggests that relevant coronary stenosis and their down-stream segments are associated with increased signal enhancement on Gadofosveset-enhanced CMR, suggesting a higher endothelial permeability in these lesions. An albumin-binding MR probe could represent a novel in vivo biomarker for the identification and characterization of these vulnerable coronary segments.

High Prevalence of Proarrhythmic Events in Patients With History of Atrial Fibrillation Undergoing a Rhythm Control Strategy: A Retrospective Study.

BACKGROUND: A retrospective study was undertaken to evaluate the respective prevalence of proarrhythmic events depending on various therapeutic regimens within a population of patients with history of atrial fibrillation (AF) undergoing a rhythm control strategy. METHODS: Inclusion criterion was the presence of AF in the patient's clinical history, whose cardioversion had been followed by the adoption of rhythm control strategy. The primary endpoint was the determination of the respective prevalences of paradoxical arrhythmias in the various therapeutic groups. The secondary objective was all-cause mortality. RESULTS: A total of 182 cases of proarrhythmia out of 624 patients were detected during a median follow-up of 20 months (interquartile range: 18 - 24 months). The prevalences of proarrhythmic events were: IC antiarrhythmic drugs + beta-blockers, 111 cases out of a total of 251 patients (44.22%); amiodarone, seven cases out of a total of 230 patients (3%); sotalol, 61 cases out of a total of 140 patients (43.57%); quinidine + digoxin, three cases out of a total of three patients (100%). The paradoxical arrhythmias were: torsades de pointes, second- and third-degree sino-atrial block, slow atrial flutter with 1:1 atrioventricular (AV) conduction, second-degree Mobitz II AV block, and sustained monomorphic ventricular tachycardia. No fatal case of proarrhythmia was found. CONCLUSIONS: Secondary prevention of AF relapses by means of drugs suitable for accomplishing rhythm control strategy exposes the patients to incumbent risk of proarrhythmic events. Thus, the choice to avoid some varieties of antiarrhythmics with marked proarrhythmic potential (class IC drugs, sotalol, quinidine) appears to be warranted.