Long-Term Prognosis of Takotsubo Syndrome

Aug 14, 2018
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Authors:
Ghadri JR, Kato K, Cammann VL, et al.
Citation:
Long-Term Prognosis of Patients With Takotsubo Syndrome. J Am Coll Cardiol 2018;72:874-882.
Summary By:
Debabrata Mukherjee, MD, FACC

Study Questions:

What are the short- and long-term outcomes in Takotsubo syndrome (TTS) based on different triggers?

Methods:

The investigators enrolled patients with TTS from the International Takotsubo Registry. Long-term mortality of patients with TTS was compared to an age- and sex-matched cohort of patients with acute coronary syndrome (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 related to physical stress showed higher mortality rates than ACS patients during long-term follow-up, whereas those with TTS related to emotional stress had better outcomes compared with ACS patients.

Conclusions:

The authors concluded that overall, TTS patients had long-term outcomes comparable to age- and sex-matched ACS patients.

Perspective:

This study reports that overall, TTS patients had a similar long-term outcome compared with age- and sex-matched ACS patient outcomes. Furthermore, TTS can either be benign or a life-threatening condition depending on the inciting stress factor. TTS patients with events related to emotional stress appear to have a favorable short- and long-term prognosis, but TTS secondary to neurologic diseases have the worst short-term prognosis. In fact, TTS secondary to neurologic diseases and TTS secondary to physical activities, medical conditions, or procedures had significantly higher mortality rates compared with ACS during long-term follow-up. Perhaps an individualized approach to TTS based on trigger may improve prognosis.

Keywords: Acute Coronary Syndrome, Exercise, Heart Failure, Nervous System Diseases, Precipitating Factors, Prognosis, Secondary Prevention, Stress, Psychological, Takotsubo Cardiomyopathy


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