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Heart, Lung and Circulation

Type of Stressor and Medium-Term Outcomes After Takotsubo Syndrome: What Becomes of the Broken Hearted? (ANZACS-QI 59)

Published:November 03, 2021DOI:https://doi.org/10.1016/j.hlc.2021.09.021

      Background

      Takotsubo syndrome (TS) is often triggered by an acute physical or emotional stressor. We hypothesised that medium-term prognosis may be better for TS patients with an associated emotional stressor than for those with an acute physical illness.

      Methods

      We identified consecutive TS patients presenting in New Zealand (2006–2018). The clinical presentation and outcomes of TS patients according to types of stressor (physical, emotional or no stressor) were assessed. Post-discharge survival after TS was compared with age- and gender-matched patients after myocardial infarction (MI) and people in the community without known cardiovascular disease (CVD).

      Results

      Of 632 TS patients (95.9% women, mean age 65.0±11.1 years), 27.4% had an associated acute physical stressor, 46.4% an emotional stressor and 26.2% no evident stressor. In-hospital mortality was similar for each group (1.7%, 1.2%, 0.3% respectively, p=0.29).
      In a median 4.4 years post-discharge there were 54 deaths (53 non-cardiac). Compared with patients without known CVD, TS patients with physical stress and those with MI were less likely to survive (HR 4.46, 95%CI 3.10–6.42; HR 4.23, 95%CI 3.81–4.70 respectively) but survival for TS patients associated with emotional stress or no stressor was similar (HR 1.11, 95%CI 0.66–1.85; HR 1.08, 95%CI 0.54–2.18, respectively). Recurrence was similar among the three groups (p=0.14).

      Conclusion

      Takotsubo syndrome associated with physical stressor has a post-discharge mortality risk as high as after MI. In contrast, prognosis for TS triggered by an emotional stressor is excellent, and similar to that of those without known CVD.

      Keywords

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      References

        • Looi J.L.
        • Lee M.
        • Webster M.W.I.
        • To A.C.Y.
        • Kerr A.J.
        Postdischarge outcome after Takotsubo syndrome compared with patients post-ACS and those without prior CVD: ANZACS-QI 19.
        Open Heart. 2018; 5: e000918
        • Ghadri J.R.
        • Kato K.
        • Cammann V.L.
        • Gili S.
        • Jurisic S.
        • Di Vece D.
        • et al.
        Long-term prognosis of patients with Takotsubo syndrome.
        J Am Coll Cardiol. 2018; 72: 874-882
        • Prasad A.
        • Lerman A.
        • Rihal C.S.
        Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction.
        Am Heart J. 2008; 155: 408-417
        • Ghadri J.R.
        • Wittstein I.S.
        • Prasad A.
        • Sharkey S.
        • Dote K.
        • Akashi Y.J.
        • et al.
        International Expert Consensus Document on Takotsubo Syndrome (Part I): clinical characteristics, diagnostic criteria, and pathophysiology.
        Eur Heart J. 2018; 39: 2032-2046
        • Yerasi C.
        • Koifman E.
        • Weissman G.
        • Wang Z.
        • Torguson R.
        • Gai J.
        • et al.
        Impact of triggering event in outcomes of stress-induced (Takotsubo) cardiomyopathy.
        Eur Heart J Acute Cardiovasc Care. 2017; 6: 280-286
        • Brinjikji W.
        • El-Sayed A.M.
        • Salka S.
        In-hospital mortality among patients with takotsubo cardiomyopathy: a study of the National Inpatient Sample 2008 to 2009.
        Am Heart J. 2012; 164: 215-221
        • Wells S.
        • Riddell T.
        • Kerr A.
        • Pylypchuk R.
        • Chelimo C.
        • Marshall R.
        • et al.
        Cohort profile: the PREDICT cardiovascular disease cohort in New Zealand primary care (PREDICT-CVD 19).
        Int J Epidemiol. 2017; 46: 22
        • Looi J.L.
        • Wong C.W.
        • Khan A.
        • Webster M.
        • Kerr A.J.
        Clinical characteristics and outcome of apical ballooning syndrome in Auckland, New Zealand.
        Heart Lung Circ. 2012; 21: 143-149
        • Templin C.
        • Ghadri J.R.
        • Napp L.C.
        Takotsubo (stress) cardiomyopathy.
        N Engl J Med. 2015; 373: 2689-2691
        • Sharkey S.W.
        • Windenburg D.C.
        • Lesser J.R.
        • Maron M.S.
        • Hauser R.G.
        • Lesser J.N.
        • et al.
        Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy.
        J Am Coll Cardiol. 2010; 55: 333-341
        • Kato K.
        • Kitahara H.
        • Fujimoto Y.
        • Sakai Y.
        • Ishibashi I.
        • Himi T.
        • et al.
        Prevalence and clinical features of focal Takotsubo cardiomyopathy.
        Circ J. 2016; 80: 1824-1829
        • Looi J.L.
        • Verryt T.
        • McLeod P.
        • Chan C.
        • Pemberton J.
        • Webster M.
        • et al.
        A comparison of the clinical features and outcomes of Takotsubo syndrome across five metropolitan hospitals in New Zealand.
        N Z Med J. 2020; 133: 73-82
        • Templin C.
        • Ghadri J.R.
        • Diekmann J.
        • Napp L.C.
        • Bataiosu D.R.
        • Jaguszewski M.
        • et al.
        Clinical features and outcomes of Takotsubo (stress) cardiomyopathy.
        N Engl J Med. 2015; 373: 929-938
        • Kato K.
        • Lyon A.R.
        • Ghadri J.R.
        • Templin C.
        Takotsubo syndrome: aetiology, presentation and treatment.
        Heart. 2017; 103: 1461-1469
        • Singh K.
        • Carson K.
        • Shah R.
        • Sawhney G.
        • Singh B.
        • Parsaik A.
        • et al.
        Meta-analysis of clinical correlates of acute mortality in takotsubo cardiomyopathy.
        Am J Cardiol. 2014; 113: 1420-1428
        • Isogai T.
        • Yasunaga H.
        • Matsui H.
        • Tanaka H.
        • Ueda T.
        • Horiguchi H.
        • et al.
        Out-of-hospital versus in-hospital Takotsubo cardiomyopathy: analysis of 3719 patients in the diagnosis procedure combination database in Japan.
        Int J Cardiol. 2014; 176: 413-417
        • Parodi G.
        • Del Pace S.
        • Carrabba N.
        • Salvadori C.
        • Memisha G.
        • Simonetti I.
        • et al.
        Incidence, clinical findings, and outcome of women with left ventricular apical ballooning syndrome.
        Am J Cardiol. 2007; 99: 182-185
        • Bybee K.A.
        • Prasad A.
        • Barsness G.W.
        • Lerman A.
        • Jaffe A.S.
        • Murphy J.G.
        • et al.
        Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome.
        Am J Cardiol. 2004; 94: 343-346
        • Sharkey S.W.
        • Lesser J.R.
        • Zenovich A.G.
        • Maron M.S.
        • Lindberg J.
        • Longe T.F.
        • et al.
        Acute and reversible cardiomyopathy provoked by stress in women from the United States.
        Circulation. 2005; 111: 472-479
        • Wittstein I.S.
        • Thiemann D.R.
        • Lima J.A.
        • Baughman K.L.
        • Schulman S.P.
        • Gerstenblith G.
        • et al.
        Neurohumoral features of myocardial stunning due to sudden emotional stress.
        N Engl J Med. 2005; 352: 539-548
        • Redfors B.
        • Vedad R.
        • Angeras O.
        • Ramunddal T.
        • Petursson P.
        • Haraldsson I.
        • et al.
        Mortality in takotsubo syndrome is similar to mortality in myocardial infarction - a report from the SWEDEHEART registry.
        Int J Cardiol. 2015; 185: 282-289
        • Auger N.
        • Paradis G.
        • Healy-Profitos J.
        • He S.
        • Potter B.J.
        Outcomes of Takotsubo syndrome at 15 years: a matched cohort study.
        Am J Med. 2020; 133: 627-634 e4
        • Stiermaier T.
        • Moeller C.
        • Oehler K.
        • Desch S.
        • Graf T.
        • Eitel C.
        • et al.
        Long-term excess mortality in takotsubo cardiomyopathy: predictors, causes and clinical consequences.
        Eur J Heart Fail. 2016; 18: 650-656
        • Elesber A.A.
        • Prasad A.
        • Lennon R.J.
        • Wright R.S.
        • Lerman A.
        • Rihal C.S.
        Four-year recurrence rate and prognosis of the apical ballooning syndrome.
        J Am Coll Cardiol. 2007; 50: 448-452
        • Tornvall P.
        • Collste O.
        • Ehrenborg E.
        • Jarnbert-Petterson H.
        A case-control study of risk markers and mortality in Takotsubo stress cardiomyopathy.
        J Am Coll Cardiol. 2016; 67: 1931-1936
        • Sharkey S.W.
        • Maron B.J.
        Epidemiology and clinical profile of Takotsubo cardiomyopathy.
        Circ J. 2014; 78: 2119-2128
        • Borchert T.
        • Hubscher D.
        • Guessoum C.I.
        • Lam T.D.
        • Ghadri J.R.
        • Schellinger I.N.
        • et al.
        Catecholamine-dependent beta-adrenergic signaling in a pluripotent stem cell model of Takotsubo cardiomyopathy.
        J Am Coll Cardiol. 2017; 70: 975-991