Clinical Characteristics and Outcomes of Patients With Takotsubo Syndrome Complicated With Acute Mitral Regurgitation

Background: Acute mitral regurgitation (MR) is a serious complication of takotsubo syndrome (TTS). However, its incidence and prognostic implications are still poorly investigated. Objectives: This study aimed to assess the clinical characteristics, short- and long-term outcomes of patients with TTS complicated by acute, reversible, moderate or severe MR. Methods: The study included TTS patients from the Takotsubo Italian Network multicenter registry. The primary outcome was the composite of in-hospital acute heart failure, cardiogenic shock, and mortality. Secondary outcomes included mortality and the recurrence of TTS at the longest available follow-up. The propensity score weighting technique was performed to account for potential confounders between patients with and without acute moderate or severe MR. Results: The study included 1,025 patients (mean age 70 ± 11 years, 91.6% females); of them, 186 (18.2%) showed acute moderate or severe MR. Logistic regression analysis showed a significantly higher risk for the primary outcome (adjusted OR: 2.29; 95% CI: 1.83-2.88), acute heart failure (adjusted OR: 2.17; 95% CI: 1.70-2.77), and cardiogenic shock (adjusted OR: 2.46; 95% CI: 1.69-3.59) in patients with acute MR compared to those without. Also, the coexistence of left ventricular outflow tract obstruction with acute MR further increased the risk for the primary outcome (adjusted OR: 5.26; 95% CI: 3.22-8.59). At long-term follow-up (median 29 months), patients who developed acute MR during hospitalization showed a significantly higher risk of mortality (adjusted HR: 1.82; 95% CI: 1.21-2.74). Conclusions: In this real-world study, acute MR was associated with a significantly higher risk of adverse events during hospitalization and long-term mortality. Early echocardiographic detection of acute MR can support prognostic stratification and management of TTS patients.