Abstract 14730: Acute Heart Failure in Apical Ballooning Syndrome: Clinical Correlates and Risk Score
Aim: Acute heart failure (HF) is a common complication of apical ballooning syndrome (ABS). We studied the frequency, risk factors and prognosis of HF in ABS and developed a clinical risk score for predicting HF.
Methods and results: In a cohort of 118 consecutive ABS patients, 53 (45%) developed HF and 25 (21%) developed cardiogenic shock. Older age [OR 1.06 (1.02 – 1.11)], preceding physical stress [OR 4.01 (1.64 – 10.36)], lower ejection fraction (EF) [OR 0.96 (0.92 – 0.99)] and higher troponin T on admission [OR 2.43 (1.05 – 6.59)] were independent predictors of HF in multivariate analysis (p<0.05). The risk score, consisting of 1 point each for age > 70 years, EF < 40% and physical stress, was highly predictive of HF in the development cohort (C-statistic 0.78). HF occurred in 8%, 27%, 59% and 85% of patients with 0, 1, 2 and 3 risk factors respectively. The risk score was validated in an independent cohort of 52 ABS patients (C-statistic 0.77). Patients with HF required greater hemodynamic support and had longer hospital stay [11.2±5.4 vs 5.4±8.7 days, p=0.0004]. Death occurred in 3 patients, all had cardiogenic shock. Supportive management of HF led to complete resolution of heart failure symptoms and LV systolic dysfunction in the survivors.
Conclusions: Acute HF of varying severity develops in approximately half of all ABS patients and is associated with higher morbidity. We present the risk factors for HF for the first time in this population. The proposed risk score accurately identifies those at risk, and may be helpful in clinical decision making.
- © 2010 by American Heart Association, Inc.