Predictive value of QRS duration at admission for in-hospital clinical outcome of Takotsubo cardiomyopathy

Tetsuo Yamaguchi, Tsutomu Yoshikawa, Toshiaki Isogai, Takamichi Miyamoto, Yuichiro Maekawa, Tetsuro Ueda, Konomi Sakata, Tsutomu Murakami, Takeshi Yamamoto, Ken Nagao, Morimasa Takayama

Research output: Contribution to journalArticle

4 Citations (Scopus)

Abstract

Background: Prolonged QRS duration (pQRSd) on electrocardiogram (ECG) is a strong predictor of poor outcome in heart failure, myocardial infarction, and myocarditis, but it is unclear whether pQRSd also predicts poor outcomes of takotsubo cardiomyopathy (TC). Methods and Results: Between 1 January 2010 and 31 December 2012, we retrospectively enrolled 299 patients with TC (mean age, 73.5± 11.7 years; 21.4% male) from the Tokyo CCU Network database, which consists of 71 cardiovascular centers in the metropolitan area. In-hospital clinical outcomes were compared between patients with pQRSd on admission ECG (QRS ≥120 ms; n=34) and those with normal QRS duration (<120 ms; n=265). The in-hospital mortality rate for pQRSd was significantly higher than that for normal QRS duration (23.5% vs. 3.8%, P<0.001). Similarly, prevalence of ventilator use (38.2% vs. 11.4%, P<0.001), ventricular tachycardia or fibrillation (14.7% vs. 1.5%, P<0.001), and circulatory failure requiring catecholamine or cardiopulmonary supportive devices (41.2% vs. 14.0%, P<0.001) was significantly higher in the pQRSd group. On multivariate logistic regression analysis, pQRSd was an independent predictor for both in-hospital mortality (OR, 5.06; 95% CI: 1.79–14.30, P=0.002) and cardiac death (OR, 7.34; 95% CI: 1.33–40.51, P=0.02). Conclusions: TC with pQRSd is associated with poor in-hospital clinical outcome. Aggressive intervention may be required to prevent severe complications in these patients.

Original languageEnglish
Pages (from-to)62-68
Number of pages7
JournalCirculation Journal
Volume81
Issue number1
DOIs
Publication statusPublished - 2017
Externally publishedYes

Fingerprint

Takotsubo Cardiomyopathy
Hospital Mortality
Electrocardiography
Tokyo
Myocarditis
Ventricular Fibrillation
Mechanical Ventilators
Ventricular Tachycardia
Catecholamines
Shock
Heart Failure
Logistic Models
Myocardial Infarction
Regression Analysis
Databases
Equipment and Supplies
Mortality

Keywords

  • Electrocardiography
  • Prolonged QRS duration
  • Takotsubo cardiomyopathy

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Yamaguchi, T., Yoshikawa, T., Isogai, T., Miyamoto, T., Maekawa, Y., Ueda, T., ... Takayama, M. (2017). Predictive value of QRS duration at admission for in-hospital clinical outcome of Takotsubo cardiomyopathy. Circulation Journal, 81(1), 62-68. https://doi.org/10.1253/circj.CJ-16-0912

Predictive value of QRS duration at admission for in-hospital clinical outcome of Takotsubo cardiomyopathy. / Yamaguchi, Tetsuo; Yoshikawa, Tsutomu; Isogai, Toshiaki; Miyamoto, Takamichi; Maekawa, Yuichiro; Ueda, Tetsuro; Sakata, Konomi; Murakami, Tsutomu; Yamamoto, Takeshi; Nagao, Ken; Takayama, Morimasa.

In: Circulation Journal, Vol. 81, No. 1, 2017, p. 62-68.

Research output: Contribution to journalArticle

Yamaguchi, T, Yoshikawa, T, Isogai, T, Miyamoto, T, Maekawa, Y, Ueda, T, Sakata, K, Murakami, T, Yamamoto, T, Nagao, K & Takayama, M 2017, 'Predictive value of QRS duration at admission for in-hospital clinical outcome of Takotsubo cardiomyopathy', Circulation Journal, vol. 81, no. 1, pp. 62-68. https://doi.org/10.1253/circj.CJ-16-0912
Yamaguchi, Tetsuo ; Yoshikawa, Tsutomu ; Isogai, Toshiaki ; Miyamoto, Takamichi ; Maekawa, Yuichiro ; Ueda, Tetsuro ; Sakata, Konomi ; Murakami, Tsutomu ; Yamamoto, Takeshi ; Nagao, Ken ; Takayama, Morimasa. / Predictive value of QRS duration at admission for in-hospital clinical outcome of Takotsubo cardiomyopathy. In: Circulation Journal. 2017 ; Vol. 81, No. 1. pp. 62-68.
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abstract = "Background: Prolonged QRS duration (pQRSd) on electrocardiogram (ECG) is a strong predictor of poor outcome in heart failure, myocardial infarction, and myocarditis, but it is unclear whether pQRSd also predicts poor outcomes of takotsubo cardiomyopathy (TC). Methods and Results: Between 1 January 2010 and 31 December 2012, we retrospectively enrolled 299 patients with TC (mean age, 73.5± 11.7 years; 21.4{\%} male) from the Tokyo CCU Network database, which consists of 71 cardiovascular centers in the metropolitan area. In-hospital clinical outcomes were compared between patients with pQRSd on admission ECG (QRS ≥120 ms; n=34) and those with normal QRS duration (<120 ms; n=265). The in-hospital mortality rate for pQRSd was significantly higher than that for normal QRS duration (23.5{\%} vs. 3.8{\%}, P<0.001). Similarly, prevalence of ventilator use (38.2{\%} vs. 11.4{\%}, P<0.001), ventricular tachycardia or fibrillation (14.7{\%} vs. 1.5{\%}, P<0.001), and circulatory failure requiring catecholamine or cardiopulmonary supportive devices (41.2{\%} vs. 14.0{\%}, P<0.001) was significantly higher in the pQRSd group. On multivariate logistic regression analysis, pQRSd was an independent predictor for both in-hospital mortality (OR, 5.06; 95{\%} CI: 1.79–14.30, P=0.002) and cardiac death (OR, 7.34; 95{\%} CI: 1.33–40.51, P=0.02). Conclusions: TC with pQRSd is associated with poor in-hospital clinical outcome. Aggressive intervention may be required to prevent severe complications in these patients.",
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T1 - Predictive value of QRS duration at admission for in-hospital clinical outcome of Takotsubo cardiomyopathy

AU - Yamaguchi, Tetsuo

AU - Yoshikawa, Tsutomu

AU - Isogai, Toshiaki

AU - Miyamoto, Takamichi

AU - Maekawa, Yuichiro

AU - Ueda, Tetsuro

AU - Sakata, Konomi

AU - Murakami, Tsutomu

AU - Yamamoto, Takeshi

AU - Nagao, Ken

AU - Takayama, Morimasa

PY - 2017

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N2 - Background: Prolonged QRS duration (pQRSd) on electrocardiogram (ECG) is a strong predictor of poor outcome in heart failure, myocardial infarction, and myocarditis, but it is unclear whether pQRSd also predicts poor outcomes of takotsubo cardiomyopathy (TC). Methods and Results: Between 1 January 2010 and 31 December 2012, we retrospectively enrolled 299 patients with TC (mean age, 73.5± 11.7 years; 21.4% male) from the Tokyo CCU Network database, which consists of 71 cardiovascular centers in the metropolitan area. In-hospital clinical outcomes were compared between patients with pQRSd on admission ECG (QRS ≥120 ms; n=34) and those with normal QRS duration (<120 ms; n=265). The in-hospital mortality rate for pQRSd was significantly higher than that for normal QRS duration (23.5% vs. 3.8%, P<0.001). Similarly, prevalence of ventilator use (38.2% vs. 11.4%, P<0.001), ventricular tachycardia or fibrillation (14.7% vs. 1.5%, P<0.001), and circulatory failure requiring catecholamine or cardiopulmonary supportive devices (41.2% vs. 14.0%, P<0.001) was significantly higher in the pQRSd group. On multivariate logistic regression analysis, pQRSd was an independent predictor for both in-hospital mortality (OR, 5.06; 95% CI: 1.79–14.30, P=0.002) and cardiac death (OR, 7.34; 95% CI: 1.33–40.51, P=0.02). Conclusions: TC with pQRSd is associated with poor in-hospital clinical outcome. Aggressive intervention may be required to prevent severe complications in these patients.

AB - Background: Prolonged QRS duration (pQRSd) on electrocardiogram (ECG) is a strong predictor of poor outcome in heart failure, myocardial infarction, and myocarditis, but it is unclear whether pQRSd also predicts poor outcomes of takotsubo cardiomyopathy (TC). Methods and Results: Between 1 January 2010 and 31 December 2012, we retrospectively enrolled 299 patients with TC (mean age, 73.5± 11.7 years; 21.4% male) from the Tokyo CCU Network database, which consists of 71 cardiovascular centers in the metropolitan area. In-hospital clinical outcomes were compared between patients with pQRSd on admission ECG (QRS ≥120 ms; n=34) and those with normal QRS duration (<120 ms; n=265). The in-hospital mortality rate for pQRSd was significantly higher than that for normal QRS duration (23.5% vs. 3.8%, P<0.001). Similarly, prevalence of ventilator use (38.2% vs. 11.4%, P<0.001), ventricular tachycardia or fibrillation (14.7% vs. 1.5%, P<0.001), and circulatory failure requiring catecholamine or cardiopulmonary supportive devices (41.2% vs. 14.0%, P<0.001) was significantly higher in the pQRSd group. On multivariate logistic regression analysis, pQRSd was an independent predictor for both in-hospital mortality (OR, 5.06; 95% CI: 1.79–14.30, P=0.002) and cardiac death (OR, 7.34; 95% CI: 1.33–40.51, P=0.02). Conclusions: TC with pQRSd is associated with poor in-hospital clinical outcome. Aggressive intervention may be required to prevent severe complications in these patients.

KW - Electrocardiography

KW - Prolonged QRS duration

KW - Takotsubo cardiomyopathy

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