Neutrophile-Lymphocyte Ratio and Outcome in Takotsubo Syndrome

SIMPLE SUMMARY: Takotsubo syndrome, also known as “stress-induced cardiomyopathy” is a disease of the heart that occurs after physical or emotional stress and can mimic a heart attack. Patients with this disease may become critically ill with the need for treatment at the intensive care unit or may even die. For medical professionals it is very important to identify patients that worsen. Therefore, we performed an analysis of a large registry of patients with Takotsubo syndrome in Austria that includes 338 patients. As already known, patients with reduced cardiac function (measured by “left ventricular ejection fraction”) have worse outcomes. Additionally, we present the “neutrophile lymphocyte ratio” (NLR), which is a new parameter deriving from standard blood count parameters. NLR identifies patients at high risk of complications, early mortality and death at long-term follow up. ABSTRACT: Background: Takotsubo syndrome (TTS) is an important type of acute heart failure with significant risk of acute complications and death. In this analysis we sought to identify predictors for in-hospital clinical outcome in TTS patients and present long-term outcomes. Methods: In this analysis from the Austrian national TTS registry, univariable and multivariable analyses were performed to identify significant predictors for severe in-hospital complications requiring immediate invasive treatment or leading to irreversible damage, such as cardiogenic shock, intubation, stroke, arrhythmias and death. Furthermore, the influence of independent predictors on long-term survival was evaluated. Results: A total of 338 patients (median age 72 years, 86.9% female) from six centers were included. Severe in-hospital complications occurred in 14.5% of patients. In multivariable analysis, high neutrophile-lymphocyte-ratio (NLR; OR 1.04 [95% CI 1.02–1.07], p = 0.009) and low LVEF (OR 0.92 [0.90–0.95] per %, p < 0.001) were significant predictors of severe in-hospital complications. Both the highest NLR tercile and the lowest LVEF tercile were significantly associated with reduced 5-year survival. Conclusions: Low LVEF and high NLR at admission were independently associated with increased in-hospital complications and reduced long-term survival in TTS patients. NLR is a new easy-to-measure tool to predict worse short- and long-term outcome after TTS.