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Journal Article Observational Study Ppublish 286 citations

PubMed: 30115226 DOI: 10.1016/j.jacc.2018.06.016

Long-Term Prognosis of Patients With Takotsubo Syndrome.

J Am Coll Cardiol 72(8):874-882

Authors: Jelena R Ghadri, Ken Kato, Victoria L Cammann, Sebastiano Gili, Stjepan Jurisic, Davide Di Vece, Alessandro Candreva, Katharina J Ding, Jozef Micek, Konrad A Szawan, Beatrice Bacchi, Rahel Bianchi, Rena A Levinson, Manfred Wischnewsky, Burkhardt Seifert, Susanne A Schlossbauer, Rodolfo Citro, Eduardo Bossone, Thomas Münzel, Maike Knorr, Susanne Heiner, Fabrizio D'Ascenzo, Jennifer Franke, Annahita Sarcon, L Christian Napp, Milosz Jaguszewski, Michel Noutsias, Hugo A Katus, Christof Burgdorf, Heribert Schunkert, Holger Thiele, Johann Bauersachs, Carsten Tschöpe, Burkert M Pieske, Lawrence Rajan, Guido Michels, Roman Pfister, Alessandro Cuneo, Claudius Jacobshagen, Gerd Hasenfuß, Mahir Karakas, Wolfgang Koenig, Wolfgang Rottbauer, Samir M Said, Ruediger C Braun-Dullaeus, Adrian Banning, Florim Cuculi, Richard Kobza, Thomas A Fischer, Tuija Vasankari … and 31 other authors

Affiliations

  • University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland.
  • University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland; Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy.
  • University Heart Center, Department of Cardiology, University Hospital Zurich, Zurich, Switzerland; Division of Biological Sciences, University of California, San Diego, La Jolla, California.
  • Department of Mathematics and Computer Science, University of Bremen, Bremen, Germany.
  • Department of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
  • Heart Department, University Hospital "San Giovanni di Dio e Ruggi d'Aragona", Salerno, Italy.
  • Cardiology 1, Center for Cardiology, University Medical Center Mainz, Mainz, Germany.
  • Division of Cardiology, Department of Medical Sciences, AOU Citta della Salute e della Scienza, University of Turin, Turin, Italy.
  • Department of Cardiology, Heidelberg University Hospital, Heidelberg, Germany.
  • University of Southern California, Keck School of Medicine, Los Angeles, California.
  • Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
  • First Department of Cardiology, Medical University of Gdansk, Gdansk, Poland.
  • Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle, Halle (Saale), Germany.
  • Heart and Vascular Centre Bad Bevensen, Bad Bevensen, Germany.
  • Deutsches Herzzentrum München, Technische Universität München, Munich, Germany; DZHK (German Centre for Cardiovascular Research), partner site Munich Heart Alliance, Munich, Germany.
  • Heart Center Leipzig, University Hospital, Department of Internal Medicine/Cardiology, Leipzig, Germany.
  • Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany.
  • TJ Health Partners Heart and Vascular, Glasgow, Kentucky.
  • Department of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany.
  • Krankenhaus "Maria Hilf" Medizinische Klinik, Stadtlohne, Germany.
  • Clinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany.
  • Department of General and Interventional Cardiology, University Heart Center Hamburg, Hamburg, Germany; DZHK (German Centre for Cardiovascular Research), partner site Hamburg/Kiel/Luebeck, Hamburg, Germany.
  • Department of Internal Medicine II-Cardiology, University of Ulm, Medical Center, Ulm, Germany.
  • Internal Medicine/Cardiology, Angiology, and Pneumology, Magdeburg University, Magdeburg, Germany.
  • Department of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, United Kingdom.
  • Department of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland.
  • Department of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland.
  • Heart Center, Turku University Hospital and University of Turku, Turku, Finland.

Abstract

BACKGROUND

Prognosis of Takotsubo syndrome (TTS) remains controversial due to scarcity of available data. Additionally, the effect of the triggering factors remains elusive.

OBJECTIVES

This study compared prognosis between TTS and acute coronary syndrome (ACS) patients and investigated short- and long-term outcomes in TTS based on different triggers.

METHODS

Patients with TTS were enrolled from the International Takotsubo Registry. Long-term mortality of patients with TTS was compared to an age- and sex-matched cohort of patients with ACS. In addition, short- and long-term outcomes were compared between different groups according to triggering conditions.

RESULTS

Overall, TTS patients had a comparable long-term mortality risk with ACS patients. Of 1,613 TTS patients, an emotional trigger was detected in 485 patients (30%). Of 630 patients (39%) related to physical triggers, 98 patients (6%) had acute neurologic disorders, while in the other 532 patients (33%), physical activities, medical conditions, or procedures were the triggering conditions. The remaining 498 patients (31%) had no identifiable trigger. TTS patients related to physical stress showed higher mortality rates than ACS patients during long-term follow-up, whereas patients related to emotional stress had better outcomes compared with ACS patients.

CONCLUSIONS

Overall, TTS patients had long-term outcomes comparable to age- and sex-matched ACS patients. Also, we demonstrated that TTS can either be benign or a life-threating condition depending on the inciting stress factor. We propose a new classification based on triggers, which can serve as a clinical tool to predict short- and long-term outcomes of TTS. (International Takotsubo Registry [InterTAK Registry]; NCT01947621).

MeSH

Mortality, Stress, Physiological, Classification, Acute Coronary Syndrome, Cardiology, Sex, Prognosis, Takotsubo Cardiomyopathy

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