Prevalence and impact of takotsubo syndrome in hospitalizations for acute ischemic stroke.

ABSTRACT

Takotsubo syndrome (TTS) is characterized by acute and reversible left ventricular dysfunction with apical ballooning arising during acute stress situations. Acute ischemic stroke (AIS) is one of the known triggers of TTS; however, the impact of TTS on in-hospital outcomes of AIS remains unexplored. We utilized data from the National Inpatient Sample (2007-2014) to identify admissions for AIS with TTS and evaluated the temporal trends, baseline characteristics, in-hospital complications, length of stay, and all-cause mortality. Survey multivariable logistic regression was used to compute adjusted odds ratios (OR) and 95% confidence intervals (CI). An estimated 2242 (0.4%) TTS cases were identified among AIS hospitalizations (N = 4,392,471). The frequency of TTS was higher in elderly, white, and female patients. After adjustment for confounders, TTS incidence in AIS was associated with higher odds of in-hospital complications including cardiogenic shock (OR 8.84, CI 4.07-19.17, P < 0.001), cardiac arrest (OR 3.17, CI 1.57-6.42, P = 0.001), and venous thromboembolism (OR 1.68, CI 1.14-2.47, P = 0.008). Moreover, AIS hospitalizations with TTS showed higher odds of developing respiratory failure (OR 3.13, CI 2.42-4.05, P < 0.001) and requiring mechanical ventilation/intubation (OR 4.09, CI 3.14-5.32, P < 0.001) compared to the non-TTS cohort. The AIS-TTS cohort had a longer length of stay (8.59 vs 5.22 days), and their mortality rate was twice (10.2% vs 5.1%; P < 0.001) that of those without TTS. In conclusion, the prevalence of TTS in AIS remained ∼20 times higher than in the general inpatient population and predisposed AIS patients to worse inpatient outcomes. Further studies are needed to evaluate the impact of TTS on long-term outcomes in AIS.