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Tomasino M, Vila-Sanjuán S, Vazirani R, Salamanca J, Martínez-Sellés M, Ruiz-Ruiz J, Martín A, Blanco-Ponce E, Almendro-Delia M, Corbí-Pascual M, Uribarri A, Núñez-Gil IJ. Vasoactive-Inotropic Score in Takotsubo syndrome induced cardiogenic shock. Med Intensiva 2025:502209. [PMID: 40251069 DOI: 10.1016/j.medine.2025.502209] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2024] [Revised: 02/04/2025] [Accepted: 03/19/2025] [Indexed: 04/20/2025]
Abstract
OBJECTIVE To determine the prognostic value of the Vasoactive-Inotropic Score (VIS) in patients with Takotsubo syndrome (TTS) complicated by cardiogenic shock (CS). DESIGN Retrospective cohort analysis. SETTING Multicenter registry (RETAKO) of patients diagnosed with TTS between 2003 and 2022. PATIENTS OR PARTICIPANTS A total of 1591 patients with TTS, of which 412 (26%) developed CS. INTERVENTIONS Patients were managed according to clinical criteria, with VIS calculated based on the maximum doses of inotropic and vasoactive drugs administered within the first 24 h of CS diagnosis. MAIN VARIABLES OF INTEREST 30-day and 1-year mortality rates, VIS tertile classifications. RESULTS Of the patients who developed CS, 208 received inotropic support. Patients in the highest VIS tertile had significantly higher 30-day (HR 8.80, 95% CI 1.96-39.48; p = 0.005) and 1-year (HR 4.55, 95% CI 1.11-18.63; p < 0.035) mortality compared to the lowest tertile. High VIS was also linked to increased complications, including acute kidney injury, major bleeding, and the need for mechanical circulatory support. In-hospital mortality rates were 4% for the low tertile, 14% for the middle tertile, and 47% for the high tertile (p < 0.001). CONCLUSIONS VIS is associated with worse short- and long-term outcomes in TTS complicated by CS. Further research is needed to explore potential causal pathways, if any, and to optimize therapeutic strategies for these patients.
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Affiliation(s)
- Marco Tomasino
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | - Sofía Vila-Sanjuán
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Ravi Vazirani
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | - Jorge Salamanca
- Department of Cardiology, Hospital Universitario de La Princesa, IIS-IP, Madrid, Spain
| | - Manuel Martínez-Sellés
- Cardiology Department, Hospital General Universitario Gregorio Marañón, Instituto de Investigación Sanitaria Gregorio Marañón, CIBERCV. Universidad Europea, Universidad Complutense. College of Physicians, Madrid, Spain
| | - Julio Ruiz-Ruiz
- Department of Cardiology, Hospital Universitario Valladolid, Valladolid, Spain
| | - Agustín Martín
- Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), CIBERCV, Salamanca, Spain
| | - Emilia Blanco-Ponce
- Department of Cardiology, Hospital Universitario Arnau de Vilanova, IRB LLeida, Lleida, Spain
| | | | | | - Aitor Uribarri
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Departament of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain; CIBERCV, Madrid, Spain; VHIR - Vall d'Hebron Institut de Recerca, Barcelona, Spain.
| | - Iván J Núñez-Gil
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain; Department of Cardiology, Hospital Universitario de Torrejón, Madrid, Spain
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Uribarri A, Vazirani R, Delia MA, Tomasino M, Fernández-Cordón C, Martín A, Blanco-Ponce E, Salamanca J, Corbí-Pascual M, Vedia O, Duran-Cambra A, Becerra-Muñoz VM, Lluch-Requerey C, Raposeiras-Roubin S, Guillén-Marzo M, Lopez-País J, Pérez-Castellanos A, Mayordomo PS, Martínez-Sellés M, Vila-Sanjuán S, Ródenas-Alesina E, Núñez-Gil IJ. Impact of mechanical circulatory support on outcomes in Takotsubo syndrome complicated by cardiogenic shock: Insights from the RETAKO registry. Int J Cardiol 2025; 419:132681. [PMID: 39454688 DOI: 10.1016/j.ijcard.2024.132681] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/12/2024] [Revised: 09/25/2024] [Accepted: 10/22/2024] [Indexed: 10/28/2024]
Abstract
BACKGROUND Cardiogenic shock (CS) complicates Takotsubo syndrome (TTS), significantly affecting patient outcomes. Since avoiding catecholamines, particularly inotropic agents, is recommended in TTS, temporary mechanical circulatory support (MCS) shows promise as a bridge to recovery. However, there is no prospective data on its use in TTS. METHODS Patients from the prospective nationwide RETAKO registry were included and divided based on the use and type of MCS. RESULTS From a national TTS registry, 1591 consecutive patients were initially enrolled between 2003 and 2022. Of these, 322 patients (20.2 %) developed CS, and 31 (9.6 %) were treated with MCS [20 intra-aortic balloon pump (IABP) (64.5 %), 8 veno-arterial extracorporeal membrane oxygenation (25.8 %), and 3 Impella-CP (9.7 %)]. Compared to CS patients managed only with drugs, MCS recipients exhibited a more severe clinical profile, with worse ventricular function and more right ventricular involvement. Despite encountering more complications, such as major bleeding and atrial fibrillation, MCS did not significantly influence in-hospital mortality (19.4 % in the MCS group vs 13.1 % in the no MCS group, p = 0.33). After adjusting for other predictors of in-hospital mortality (invasive mechanical ventilation, inotropic-vasoactive score, age, and SCAI stage), MCS was not associated with higher mortality. CONCLUSION Approximately 10 % of TTS patients complicated by CS were treated with MCS. Despite their more severe CS, patients treated with MCS had similar in-hospital mortality rates as those treated only with drugs, suggesting a potential benefit of MCS in selected cases.
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Affiliation(s)
- Aitor Uribarri
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBERCV, Spain; Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain.
| | - Ravi Vazirani
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | - Marco Tomasino
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain
| | | | - Agustín Martín
- Department of Cardiology, Hospital Universitario de Salamanca, Instituto de Investigación Biomédica de Salamanca (IBSAL), CIBERCV, Salamanca, Spain
| | - Emilia Blanco-Ponce
- Department of Cardiology, Hospital Universitario Arnau de Vilanova, IRB LLeida, Lleida, Spain.
| | - Jorge Salamanca
- Department of Cardiology, Instituto de Investigación Sanitaria Princesa (IIS-IP), Hospital Universitario de La Princesa, Madrid, Spain
| | | | - Oscar Vedia
- Department of Cardiology, Hospital Clínico San Carlos, Madrid, Spain
| | | | | | | | | | - Marta Guillén-Marzo
- Department of Cardiology, Hospital Universitario Joan XXIII, Tarragona, Spain
| | - Javier Lopez-País
- Department of Cardiology, Hospital Universitario de Orense, Orense, Spain
| | | | | | - Manuel Martínez-Sellés
- Department of Cardiology, Hospital Universitario Gregorio Marañón, Madrid, Spain; Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain.
| | - Sofía Vila-Sanjuán
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Department of Medicine, Universitat Autònoma de Barcelona, Barcelona, Spain
| | - Eduard Ródenas-Alesina
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; CIBERCV, Spain; Vall d'Hebron Institut de Recerca (VHIR), Barcelona, Spain
| | - Iván J Núñez-Gil
- Department of Cardiology, Hospital Universitari Vall d'Hebron, Barcelona, Spain; Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Villaviciosa de Odón, Spain; Department of Cardiology, Hospital Universitario de Torrejón, Madrid, Spain
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Ramírez-Aragón S, Del Pino-Camposeco J, Villanueva-Castro E, Canela-Calderon O, Arriada-Mendicoa JN, Ponce-Gómez JA. A Postoperative Complication of Takotsubo Syndrome in the Spinal Surgery: A Case Report. Cureus 2023; 15:e51034. [PMID: 38264385 PMCID: PMC10805121 DOI: 10.7759/cureus.51034] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 12/24/2023] [Indexed: 01/25/2024] Open
Abstract
We present the case of a 32-year-old woman with a diagnosis of lumbar root syndrome and spondylolisthesis, which is why she underwent surgery. Anterior discectomy and intersomatic box placement plus posterior fixation were performed with percutaneous transpedicular screws in L5-S1. At 24 hours of the procedure, the patient presents sustained hypotension, adding sudden and intense chest pain with neck irradiation, dyspnea, and diaphoresis, as well as electrocardiographic abnormalities and elevation of cardiac enzymes suggestive of an acute coronary syndrome, subsequently evidence of basal hypokinesis in the echocardiogram. After providing hemodynamic support and analgesic management, the symptoms were resolved, and the electrocardiogram (ECG) and cardiac enzymes were normalized, allowing an adequate postoperative evolution.
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Affiliation(s)
- Sergio Ramírez-Aragón
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Jorge Del Pino-Camposeco
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Eliezer Villanueva-Castro
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | - Obet Canela-Calderon
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
| | | | - Juan Antonio Ponce-Gómez
- Department of Neurosurgery, Instituto Nacional de Neurología y Neurocirugía Manuel Velasco Suárez, Mexico City, MEX
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