Abstract 4146892: Takotsubo cardiomyopathy with Cirrhosis - Mortality and Outcomes among hospitalised patients in the United States

Background: Takotsubo cardiomyopathy (TCM) is a unique and reversible heart condition typically triggered by intense emotional or physical stress. Meanwhile, Cirrhosis, a chronic liver disease, is associated with increasing inflammation and oxidative stress, which can potentially worsen cardiovascular problems. In this study, we aimed to study the impact of cirrhosis on outcomes in TCM. Methods: A retrospective analysis was performed using the NIS database 2016 -2020 and the International Classification of Diseases, Tenth Revision codes to identify patients > 18 years old with the principal diagnosis of Takotsubo cardiomyopathy. The effect of cirrhosis was studied on in-hospital mortality and secondary outcomes such as cardiogenic shock, ventricular arrhythmia (VA), acute respiratory and acute kidney injury (AKI), as well as resource utilisation. Categorical variables were compared using the chi-square test, and continuous variables were compared using the t-test—multivariable regression analyses adjusted for demographics, hospital-level characteristics, and relevant comorbidities. Results: We identified a total of 190,025 patients with TCM. Of these, 3,335 (1.76%) patients had liver cirrhosis, with notably higher prevalence of diabetes (33.6%), CKD (20.7%), anemia (10.2%), and major depressive disorder (25.6%) in the cirrhosis group. A higher incidence of in-hospital mortality (12.9% vs. 6.3%, p<0.001), cardiogenic shock (11.7% vs. 6.5%, p<0.001), AKI (41.4% vs. 22.8%, p<0.001), and ARF (40% vs. 31.6%) was noted in the cirrhosis group. After adjusting for confounding factors, the liver cirrhosis group had higher odds of in-hospital mortality (aOR 1.39, 95% CI 1.1-1.75, p=0.006), AKI (aOR 1.53, 95% CI 1.28-1.82, p<0.001), longer length of stay (11.2 days vs. 6.8 days, p<0.001), and higher total hospitalization charges ($198,786 vs. $99,712, p<0.001). The relationship between cirrhosis and cardiovascular outcomes such as cardiogenic shock (aOR 1.23, 95% CI 0.95-1.58, p=0.116) and VA (aOR 1.01, 95% CI 0.75-1.36, p=0.942) was not statistically significant. Discussion: Our study noted that TCM patients with cirrhosis had higher in-hospital mortality and resource utilization. There was no statistically significant relationship between cirrhosis and cardiovascular outcomes suggestive of the adverse consequences to be related to cirrhosis itself rather than TCM.