Admission heart rate and in-hospital course of patients with Takotsubo syndrome

Luca Arcari, Luca Rosario Limite, Luca Cacciotti, Matteo Sclafani, Domitilla Russo, Ilaria Passaseo, Giuseppe Marazzi, Gerardo Ansalone, Massimo Volpe, Camillo Autore, Maria Beatrice Musumeci

Research output: Contribution to journalArticlepeer-review


Background: In-hospital course of patients with Takotsubo syndrome (TS) is quite heterogeneous and life-threatening complications are not uncommon in the acute phase. The role of heart rate (HR) as a predictor of prognosis has not been sufficiently investigated in this setting. The study aims to assess the impact of HR at presentation on in-hospital course of patients with TS. Methods: The study population included 221 patients with TS enrolled in a multicentric registry. HR at admission was evaluated on the first electrocardiogram. According to tertile distribution of HR at presentation, 3 groups were identified: Group A (HR ≤ 76 beats per minute (bpm), n = 76), Group B (HR 77–95 bpm, n = 74) and Group C (HR > 95 bpm, n = 71). Acute in-hospital complications were defined as occurrence of severe pump failure and major arrhythmias. Results: 32 (14.4%) patients experienced complicated in-hospital course. HR on admission was significantly higher (108 bpm vs. 85 bpm; p < 0.001) and ejection fraction (EF) lower (35% vs. 40%; p = 0.009) in patients with complications than in those without. Patients in Group C experienced a 5-fold higher rate of complications compared to group A and B. After multivariate analysis, higher HR (odds ratio 1.34 per 10 bpm increase, 95% confidence interval (CI) 1.12–1.59; p = 0.001) and lower EF (odds ratio 1.24 per 5% decrease, 95% CI 1.01–1.54; p = 0.049) remained independently associated with a worse outcome. Conclusion: In a large population with TS, high HR on admission independently predicted complicated in-hospital course.

Original languageEnglish
Pages (from-to)15-21
Number of pages7
JournalInternational Journal of Cardiology
Publication statusPublished - Dec 15 2018


  • Acute pulmonary oedema
  • Heart rate
  • Prognosis
  • Shock
  • Takotsubo syndrome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine


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