Temporal Trends in Takotsubo Syndrome

Sep 25, 2024
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Authors:
Schweiger V, Cammann VL, Crisci G, et al.
Citation:
Temporal Trends in Takotsubo Syndrome: Results From the International Takotsubo Registry. J Am Coll Cardiol 2024;84:1178-1189.
Summary By:
Bina Ahmed, MD, FACC

Quick Takes

  • The current analysis from the InterTAK registry of patients with Takotsubo syndrome (TTS) reported clinical trends spanning 15 years.
  • There was an increase in TTS among men, although female patients represented 88% of the overall cohort.
  • Nonapical variants were increasingly identified and physical triggers became more common than emotional triggers.
  • Although there was no significant change in long-term mortality trends, there was an increase in TTS with cardiogenic shock and short-term mortality (60 days).

Study Questions:

What are temporal trends in demographic patterns, risk factors, clinical presentations, and outcomes in patients with Takotsubo syndrome (TTS)?

Methods:

Patients diagnosed with TTS between 2004 and 2021 were enrolled from the InterTAK (International Takotsubo) registry. To assess temporal trends, patients were divided into six groups, each corresponding to a 3-year interval within the study period.

Results:

Overall, 3,957 patients were included in the study. There was a significant demographic transition, with the proportion of male patients rising from 10% to 15% (p = 0.003). Although apical TTS remained the most common form, the diagnosis of midventricular TTS increased from 18% to 28% (p = 0.018). The prevalence of physical triggers increased from 39% to 58% over the years (p < 0.001). There was a significant increase in 60-day mortality over the years (p < 0.001). However, a landmark analysis excluding patients who died within the first 60 days showed no differences in 1-year mortality (p = 0.150).

Conclusions:

This study of temporal trends in TTS highlights a transition in patient demographics with a growing prevalence among men, increasing recognition of midventricular TTS type, and increased short-term mortality and rates of cardiogenic shock in recent years. This transition aligns with the rising prevalence of physical triggers, as an expression of increased recognition of TTS in association with acute comorbidities.

Perspective:

The current analysis from the InterTAK registry of patients with TTS reported clinical trends spanning 15 years. There was an increase in TTS among men, although female patients represented 88% of the overall cohort. Nonapical variants were increasingly identified and physical triggers became more common than emotional triggers. Although there was no significant change in long-term mortality trends, there was an increase in TTS with cardiogenic shock and short-term mortality (60 days). Though there are inherent biases based on increasing recognition of TTS, continued analysis from this important registry will help us evolve our understanding of this mysterious, complex, and clinically relevant entity.

Clinical Topics: Heart Failure and Cardiomyopathies

Keywords: Cardiomyopathies, Takotsubo Cardiomyopathy


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