Hyponatremia in takotsubo syndrome is associated with attenuated in-hospital improvement of left ventricular ejection fraction and higher long-term mortality

Karolina Eliasz; Konrad Stępień; Maria Królikowska; Maja Wojtylak; Oliwia Andrasz; Katarzyna Majka; Karol Nowak; Aleksander Siniarski; Jadwiga M. Nessler; Jarosław Zalewski

doi:10.5114/aic.2025.154247

eISSN: 1897-4295
ISSN: 1734-9338

Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej

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3/2025
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abstract:

Original paper

Hyponatremia in takotsubo syndrome is associated with attenuated in-hospital improvement of left ventricular ejection fraction and higher long-term mortality

Karolina Eliasz

¹

,

Konrad Stępień

^{1, 2}

,

Maria Królikowska

¹

,

Maja Wojtylak

³

,

Oliwia Andrasz

³

,

Katarzyna Majka

³

,

Karol Nowak

^{1, 2}

,

Aleksander Siniarski

^{1, 4}

,

Jadwiga M. Nessler

^{1, 4}

,

Jarosław Zalewski

^{1, 4}

Department of Coronary Artery Disease and Heart Failure, St. John Paul II Hospital, Krakow, Poland
Department of Thromboembolic Disorders, Jagiellonian University Medical College, Krakow, Poland
Student Research Group at the Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Krakow, Poland
Department of Coronary Artery Disease and Heart Failure, Jagiellonian University Medical College, Krakow, Poland

Adv Interv Cardiol 2025; 21, 3 (81): 350–357

DOI: https://doi.org/10.5114/aic.2025.154247

Online publish date: 2025/09/15

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AMA

Eliasz K, Stępień K, Królikowska M, et al. Hyponatremia in takotsubo syndrome is associated with attenuated in-hospital improvement of left ventricular ejection fraction and higher long-term mortality. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2025;21(3):350-357. doi:10.5114/aic.2025.154247.

APA

Eliasz, K., Stępień, K., Królikowska, M., Wojtylak, M., Andrasz, O.,  & Majka, K. et al. (2025). Hyponatremia in takotsubo syndrome is associated with attenuated in-hospital improvement of left ventricular ejection fraction and higher long-term mortality. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 21(3), 350-357. https://doi.org/10.5114/aic.2025.154247

Chicago

Eliasz, Karolina, Konrad Stępień, Maria Królikowska, Maja Wojtylak, Oliwia Andrasz, Katarzyna Majka,  and Karol Nowak et al. 2025. "Hyponatremia in takotsubo syndrome is associated with attenuated in-hospital improvement of left ventricular ejection fraction and higher long-term mortality". Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej 21 (3): 350-357. doi:10.5114/aic.2025.154247.

Harvard

Eliasz, K., Stępień, K., Królikowska, M., Wojtylak, M., Andrasz, O., Majka, K., Nowak, K., Siniarski, A., Nessler, J.,  and Zalewski, J. (2025). Hyponatremia in takotsubo syndrome is associated with attenuated in-hospital improvement of left ventricular ejection fraction and higher long-term mortality. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, 21(3), pp.350-357. https://doi.org/10.5114/aic.2025.154247

MLA

Eliasz, Karolina et al. "Hyponatremia in takotsubo syndrome is associated with attenuated in-hospital improvement of left ventricular ejection fraction and higher long-term mortality." Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej, vol. 21, no. 3, 2025, pp. 350-357. doi:10.5114/aic.2025.154247.

Vancouver

Eliasz K, Stępień K, Królikowska M, Wojtylak M, Andrasz O, Majka K et al. Hyponatremia in takotsubo syndrome is associated with attenuated in-hospital improvement of left ventricular ejection fraction and higher long-term mortality. Advances in Interventional Cardiology/Postępy w Kardiologii Interwencyjnej. 2025;21(3):350-357. doi:10.5114/aic.2025.154247.

Introduction:
The clinical relevance and long-term mortality in hyponatremic patients with takotsubo syndrome (TTS) remain poorly elucidated.

Aim:
We sought to investigate whether hyponatremia identified in TTS patients influenced in-hospital and long-term outcomes in this group of patients.

Material and methods:
Among 7771 patients hospitalized with acute myocardial infarction, TTS was diagnosed in 100 (1.3%) patients. Hyponatremia on admission was defined as sodium level < 135 mmol/l. In-hospital clinical characteristics and long-term all-cause mortality were assessed in hyponatremic and normonatremic TTS patients.

Results:
On admission, hyponatremia was identified in 14 (14%) TTS patients. Hyponatremic patients were older (78.5 vs. 69 years, p = 0.013) and more frequently had a history of stroke (7.1 vs. 0%, p = 0.046) or heart failure (50 vs. 12.8%, p = 0.001) than normonatremic patients. Hyponatremic subjects more often demonstrated ST-segment elevation (78.6 vs. 48.8%, p = 0.033) and apical TTS type (100 vs. 81.4%, p = 0.021). During the index hospitalization, hyponatremic versus normonatremic TTS patients showed attenuated improvement of left ventricular ejection fraction (0 [0–5] vs. 10 [0–20]%, p = 0.039) and its lower values at discharge (40 [35–45] vs. 50 [42–55]%, p = 0.032). Within a median observation period of 53 months, higher all-cause mortality was found in hyponatremic versus normonatremic TTS patients (35.7 vs. 15.1%, p = 0.038). Cox proportional hazard regression showed that sodium plasma level on admission was independently associated with long-term mortality (HR = 0.919, 95% CI: 0.866–0.975, p = 0.005).

Conclusions:
Our pilot findings indicate that hyponatremia, observed in every seventh TTS patient, was associated with lower in-hospital left ventricular ejection fraction improvement and higher long-term all-cause mortality.

keywords:

Hyponatremia in takotsubo syndrome is associated with attenuated in-hospital improvement of left ventricular ejection fraction and higher long-term mortality

Karolina Eliasz 1 , Konrad Stępień 1, 2 , Maria Królikowska 1 , Maja Wojtylak 3 , Oliwia Andrasz 3 , Katarzyna Majka 3 , Karol Nowak 1, 2 , Aleksander Siniarski 1, 4 , Jadwiga M. Nessler 1, 4 , Jarosław Zalewski 1, 4

hyponatremia, long-term survival, takotsubo syndrome

Karolina Eliasz

¹

,

Konrad Stępień

^{1, 2}

,

Maria Królikowska

¹

,

Maja Wojtylak

³

,

Oliwia Andrasz

³

,

Katarzyna Majka

³

,

Karol Nowak

^{1, 2}

,

Aleksander Siniarski

^{1, 4}

,

Jadwiga M. Nessler

^{1, 4}

,

Jarosław Zalewski

^{1, 4}