Abstract Background There has been an increase in the number of cases of Takotsubo syndrome (TTS) and of scientific publications on the theme over the last years. However, little is known about the status of this disease in Brazilian hospitals. Objective To assess mortality and major adverse cardiovascular events (MACE) during hospitalization and follow-up of TTS patients seen in a tertiary hospital in Brazil. Methods This was a retrospective, observational study on 48 patients. Clinical data, signs and symptoms, complementary tests, MACE and all-cause mortality were assessed on admission and during follow-up. Kaplan-Meier curves were used for analysis of all-cause mortality and risk for MACE at median follow-up. The 95% confidence interval was also calculated for a significance level of 5%. Results Mean age of patients was 71 years (SD±13 years), and most patients were women (n=41; 85.4%). During hospitalization, four patients (8.3%) died and five (10.4%) developed MACE. At median follow-up of 354.5 days (IQR of 81.5-896.5 days), the risk of all-cause mortality and MACE was 11.1% (95% CI= 1.8-20.3%) and 12.7% (95% CI= 3.3-22.3%), respectively. Conclusion TTS was associated with high morbidity and mortality rates in a tertiary hospital in Brazil, which were comparable to those observed in acute coronary syndrome. Therefore, the severity of TTS should not be underestimated, and new therapeutic strategies are required. Int J Cardiovasc Sci. 2020; [online].ahead print, PP.0-0

INTRODUÇÃO: A área luminal mínima (ALM), obtida pelo ultrassom intracoronário (USIC), é preditora de eventos em pacientes com lesões de moderada gravidade, identificadas à angiografia coronária. Por outro lado, a presença de cálcio é preditora de estabilidade das lesões. O objetivo deste estudo é avaliar qual a influência da quantidade total de cálcio coronário, obtido pela tomografia computadorizada cardíaca (TCC), na gravidade de lesões moderadas, avaliadas por meio de USIC. MÉTODOS: Realizamos USIC de 27 lesões moderadas, em uma série consecutiva de 22 pacientes com indicação para o procedimento, e que tinham TCC prévia. Foram obtidas medidas da ALM, carga de placa e porcentual de área de estenose. RESULTADOS: Os pacientes eram, em sua maioria, do sexo masculino (85%), com idade de 60 ± 9 anos e 41% eram diabéticos. Observamos correlação significativa entre ALM e escore de cálcio total (r = 0,67; P = 0,002), mas não houve correlação entre escore de cálcio total e carga de placa (r = 0,02; P = 0,93) ou porcentual de área de estenose (r = 0,3; P = 0,32). Os preditores independentes da ALM na análise multivariada foram idade (P = 0,02), índice de massa corporal (P = 0,01), diabetes (P = 0,02), dislipidemia (P = 0,02), proteína C-reativa ultrassensível (P = 0,02), glicemia (P = 0,02), HDL-colesterol (P = 0,02), triglicerídeos (P = 0,02), fração de ejeção do ventrículo esquerdo < 50% (P = 0,02) e escore de cálcio total (P = 0,03). CONCLUSÕES: O escore de cálcio total apresenta correlação positiva com a ALM em artérias coronárias, sugerindo que maior quantidade de cálcio na árvore coronária implica lesões ateroscleróticas moderadas com maiores áreas luminais ao USIC.

BACKGROUND: The minimal luminal area (MLA) measured by intravascular ultrasound (IVUS) is a predictor of cardiovascular events in patients with angiographically moderate lesions. On the other hand, the presence of calcium is a predictor of lesion stability. The objective of this study is to evaluate the influence of the total amount of coronary calcium, obtained by multislice CT scanner (MDCT), on the severity of moderate lesions as assessed by IVUS. METHODS: IVUS was performed in 27 moderate lesions in a consecutive series of 22 patients with indication for the procedure who had a previous MDCT. Measurements of the minimal luminal area (MLA), plaque burden and percentage area stenosis were obtained. RESULTS: Most patients were male (85%), with mean age of 60 ± 9 years and 41% were diabetic. A significant correlation was observed between the MLA and total calcium score (r = 0.67; P = 0.002), but there was no correlation between the total calcium score and plaque burden (r = 0.02; P = 0.93) or percentage area stenosis (r = 0.3; P = 0.32). Independent predictors of MLA in the multivariate analysis were age (P = 0.02), body mass index (P = 0.01), diabetes (P = 0.02), dyslipidemia (P = 0.02), high-sensitive Creactive protein (P = 0.02), glucose (P = 0.02), HDL-cholesterol (P = 0.02), triglycerides (P = 0.02), left ventricular ejection fraction < 50% (P = 0.02) and total calcium score (P = 0.03). CONCLUSIONS: The total calcium score correlates positively with MLA in coronary arteries, suggesting that a large calcium burden in the coronary tree is related to angiographically moderate lesions with larger luminal areas at IVUS.