Log in to MyACC
Long-Term Outcome in Takotsubo Syndrome
Study Questions:
What is the incidence of long-term adverse outcomes in patients with Takotsubo syndrome (TTS)?
Methods:
The investigators searched the PubMed, Embase, and Cochrane databases and reviewed cited references up to March 31, 2018, to identify studies of patients with TTS with >6 months of follow-up data. Clinical outcomes analyzed were: 1) overall in-hospital mortality; 2) long-term mortality (i.e., total mortality, cardiac, and noncardiac deaths); and 3) overall incidence of recurrence of TTS during follow-up. Random effects meta-regression analysis was performed to measure the impact of baseline characteristics on the effect size for prespecified outcomes (in-hospital mortality, long-term total mortality, and recurrence during follow-up).
Results:
Overall, the authors selected 54 studies that included a total of 4,679 patients (4,077 women and 602 men). Death during admission occurred in 112 patients (2.4%), yielding a frequency of 1.8% (95% confidence interval [CI], 1.2-2.5%), with significant heterogeneity (I2 = 78%; p < 0.001). During a median follow-up of 28 months (interquartile range, 23-34 months), 464 of 4,567 patients who the survived index admission died (103 because of cardiac causes and 351 because of noncardiac issues). The annual rate of total mortality was 3.5% (95% CI, 2.6-4.5%), with significant heterogeneity (I2 = 74%; p < 0.001). Overall, 104 cases of recurrence of TTS were detected during follow-up, yielding a 1.0% annual rate of recurrence (95% CI, 0.7-1.3%), without significant heterogeneity (I2 = 39%; p = 0.898). Meta-regression analysis showed that long-term total mortality in each study was significantly associated with older age (p = 0.05), physical stressor (p = 0.0001), and the atypical ballooning form of TTS (p = 0.009).
Conclusions:
The authors concluded that long-term rates of overall mortality and recurrence with TTS were not trivial, and that some presenting features were significantly associated with an unfavorable long-term prognosis.
Perspective:
This systemic review reports that long-term rates of overall mortality and recurrence in patients discharged alive after TTS were not trivial. Furthermore, some presenting features (i.e., older age, physical stressor, and atypical ballooning) were significantly associated with an unfavorable long-term prognosis. Additional studies are indicated to assess whether stronger triggers (e.g., physical stressor) in more vulnerable patients (e.g., older adults) might result in a larger extent of myocardial damage, leading to global left ventricular stunning in the acute phase (e.g., atypical ballooning) and eventually to a worse outcome in the long term. Such knowledge may lead to development of mitigating treatment strategies that may help limit myocardial damage.
Clinical Topics: Cardiovascular Care Team, Geriatric Cardiology, Heart Failure and Cardiomyopathies, Prevention, Acute Heart Failure, Stress
Keywords: Cardiomyopathies, Geriatrics, Heart Failure, Hospital Mortality, Outcome Assessment, Health Care, Patient Discharge, Prognosis, Recurrence, Secondary Prevention, Stress, Physiological
< Back to Listings
