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

Abstract

To investigate admission hyperglycemia effects on the sympathetic system and long-term prognosis in Takotsubo syndrome (TTS). In patients with TTS and hyperglycemia (n = 28) versus normoglycemia (n = 48), serum norepinephrine and ¹²³I-labeled metaiodobenzylguanidine (MIBG) cardiac scintigraphy were assessed. Heart failure (HF) occurrence and death events over 2 years were evaluated. At hospitalization, those with hyperglycemia versus normoglycemia had higher levels of inflammatory markers and B-type natriuretic peptide and lower left ventricular ejection fraction. Glucose values correlated with norepinephrine levels (<i>R</i> ² = 0.39; <i>P</i> = 0.001). In 30 patients with TTS, ¹²³I-MIBG cardiac scintigraphy showed lower late heart-to-mediastinum ratio values in the acute phase (<i>P</i> < 0.001) and at follow-up (<i>P</i> < 0.001) in those with hyperglycemia. Patients with hyperglycemia had higher rates of HF (<i>P</i> < 0.001) and death events (<i>P</i> < 0.05) after 24 months. In multivariate Cox regression analysis, hyperglycemia (<i>P</i> = 0.008), tumor necrosis factor-α (<i>P</i> = 0.001), and norepinephrine (<i>P</i> = 0.035) were independent predictors of HF events. Patients with TTS and hyperglycemia exhibit sympathetic overactivity with a hyperglycemia-mediated proinflammatory pathway, which could cause worse prognosis during follow-up.