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Impact of Admission Hyperglycemia on Heart Failure Events and Mortality in Patients With Takotsubo Syndrome at Long-term Follow-up: Data From the HIGH-GLUCOTAKO Investigators

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posted on 2021-06-29, 18:05 authored by Pasquale Paolisso, Luca Bergamaschi, Pietro Rambaldi, Gianluca Gatta, Alberto Foà, Francesco Angeli, Michele Fabrizio, Gianni Casella, Michelangela Barbieri, Nazzareno Galiè, Raffaele Marfella, Carmine Pizzi, Celestino Sardu

OBJECTIVES: To investigate admission hyperglycemia effects on the sympathetic system and long-term prognosis in Takotsubo syndrome (TTS).

RESEARCH DESIGN AND METHODS: in TTS hyperglycemics (n=28) vs normoglycemics (n=48) serum norepinephrine and 123I-MIBG cardiac scintigraphy (123I-MIBGcS) were assessed. Heart failure (HF) occurrence and deaths events over 2-years were evaluated.

RESULTS: At hospitalization, hyperglycemics vs normoglycemics had higher levels of inflammatory markers, BNP and lower left ventricle ejection fraction (LVEF). Glucose values correlated with norepinephrine levels (R²=0.39, p=0.001). In 30 TTS patients, 123I-MIBGcS showed lower H/M_late valuesin the acute phase (p<0.001) and at follow-up (p<0.001) in hyperglycemic patients. Hyperglycemics had a higher rate of HF events (p<0.001) and deaths (p<0.05) after 24-months. At multivariate Cox Regression analysis, hyperglycemia (p=0.008), TNF-α (p=0.001) and norepinephrine (p=0.035) were independent predictors of HF events.

CONCLUSIONS: TTS hyperglycemic patients exhibit a sympathetic overactivity with a hyperglycemia-mediated pro-inflammatory pathway which could cause a worse prognosis during follow-up.