ABC | Volume 115, Nº2, August 2020

Original Article Almeida Junior et al. Takotsubo Multicenter Registry (REMUTA) Arq Bras Cardiol. 2020; 115(2):207-216 described as percentages. The Kolmogorov-Smirnov test was used to test the distribution pattern of numerical variables. We used Fisher’s exact or chi-square tests to compare categorical variables and identify univariate predictors of in-hospital mortality. Variables that were significant in univariate analysis were included in multivariate analysis (logistic regression) in order to identify independent predictors of mortality. P-values < 0.05 were considered statistically significant. Kaplan-Meier curves were constructed to estimate survival, and they were compared using the logrank test. Cox uni- and multivariate analyses were used to identify independent predictors of mortality after hospital discharge. The statistical program used was SPSS version 15.0. Ethical Aspects The study protocol was approved by the Research Ethics Committee of the Casa de Saúde São José, Rio de Janeiro, on November 26, 2017, under certificate (CAAE) number 80206417.5.1001.5664 and opinion number 2.399.599. Results A total of 172 patients were identified with the inclusion criteria. After analysis ofmedical records, 3patientswere excluded, because data fundamental to analysis were not registered in the records. Therefore, analysis included 169 patients who were hospitalized between October 2010 and October 2017, in 12 different centers in the state of Rio de Janeiro. Average patient age was 70.9 ± 14.1 years and 90.5% of patients were female. The most prevalent symptoms were chest pain (63.6%) and dyspnea (44.6%). History of emotional stress was present in 38.8% of patients. Table 1 shows the clinical variables of the study sample. In etiological analysis, 63% of cases were primary TTS, and 37% were secondary. Upon admission, patients presented with clinical stability, as reflected by systolic blood pressure (SBP) 126.73 ± 25.2 (average ± SD) and heart rate 86.30 ± 20 (average ± SD). Regarding complementary exams, troponin I was positive in 92.5% of patients, with median (interquartile range) of 2.37 (0.63; 4.3) for conventional and 24.3 (0.8; 2650) for ultra-sensitive. Median BNP was 395 (176.5; 1725). STE was present in 28% of patients, while ST segment depression (STD) was present in 11.8%. Table 2 shows the population’s main laboratory and ECG characteristics. All patients underwent coronarography, and non- obstructive coronary disease (< 50%) was present in 24.2% of cases. The other 75.8% had angiographically normal coronary arteries. Regarding echocardiographic analysis, median left ventricular ejection fraction (LVEF) was 40 (35; 48)% when evaluated by the Simpson method and 48 (40; 62)% when evaluated by the Teichholz method. Complete or partial reversal of LV dysfunction was evaluated, and it was present in 68.2% of cases. Table 3 shows the main echocardiographic variables analyzed, and Figure 1 shows changes in segmental contraction patterns. When analyzing medications used during the hospital stay period, we observed that betablockers (76.2%), antiplatelet agents (60.1%), angiotensin converting enzyme inhibitors or angiotensin receptor blockers (59.5%), anticoagulants (42.6%), and loop diuretics (40.9%) were predominant. Dobutamine (17.7%) and noradrenaline (21.3%) were also used in a relatively large portion of the population (Figure 2). Table 2 – Laboratory and electrocardiographic variables Variable (recorded data/total N) Result Positive troponin (161/169)(%) 92.5 Positive CK-MB (84/169) (%) 84.7 STE (161/169)(%) 28.0 STD (161/169)(%) 11.8 Complete LBBB (161/169)(%) 7.1 Changes in repolarization (161/169)(%) 52.6 BNP (45/169) (pg/ml)(median/IQR) 395 (176.5; 1725) Pro-BNP (7/169) (mean ± SD) 4068.57 ± 6121.28 Troponin I (45/169) (median/IQR) 2.37 (0.63; 4.3) US Troponin I (76/169) (median/IQR) 24.3 (0.8; 2650) BNP: brain natriuretic peptide; LBBB: left bundle branch block; CK-MB: creatine kinase myocardial band; IQR: interquartile range; SD: standard deviation; STD: ST-segment depression; STE: ST-segment elevation; US: ultra-sensitive. Table 1 – Clinical variables of the sample Variable REMUTA (N = 169) Age (mean ± SD) 70.9 ± 14.1 Male sex (%) 9.47 Chest pain (%) 63.6 Dyspnea (%) 44.6 Arterial hypertension (%) 69.7 Diabetes (%) 24.2 Dyslipidemia (%) 37.6 Chronic renal disease (%) 5.4 AF/flutter (%) 21.2 Tobacco use (%) 17.6 Obesity (%) 18.2 Emotional stress (%) 38.8 SBP (mmHg) (average ± SD) 126.73 ± 25.2 DBP (mmHg) (average ± SD) 72.99 ± 15.6 MBP (mmHg) (average ± SD) 90.50 ± 17.8 HR (BPM) (average ± SD) 86.30 ± 20.0 Length of hospital stay (days) (median/IQR) 7.5 (5; 16) AF: atrial fibrillation; DBP: diastolic blood pressure; HR: heart rate; IQR: interquartile range; MBP: mean blood pressure; SBP: systolic blood pressure; SD: standard deviation. 209