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Int J Cardiol. 2018 Sep 15;267:22-27. doi: 10.1016/j.ijcard.2018.04.139.

Natural history and predictors of mortality of patients with Takotsubo syndrome.

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Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA; Division of Cardiology, Kosin University Gospel Hospital, Busan, Republic of Korea.
Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA.
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA. Electronic address:



Takotsubo syndrome is a unique transient cardiomyopathy. The pathogenesis, management, and long-term prognosis of Takotsubo syndrome are incompletely understood. The study was designed to evaluate the natural history and determinants of outcomes in patients with Takotsubo syndrome patients.


We analyzed 265 patients in the Mayo Clinic Takotsubo syndrome registry for clinical presentation, treatment, and long-term outcomes with a focus on identifying prognostic factors for mortality and recurrence.


95% of patients were women with a mean age of 70 ± 11.8 years. Among 257 patients discharged alive, there were 89 (34.6%) deaths, 18 (6.8%) non-fatal myocardial infarction, 12 (4.7%) cerebrovascular accidents and 23 (8.9%) re-hospitalization for heart failure over a mean follow-up of 5.8 ± 3.6 years. Only 4 (5%) patients died from cardiac causes. Cancer was the single leading cause of death. Overall 1-year survival rate was 94.2%. Independent prognostic predictors of mortality were a history of cancer (HR 2.004, 1.334-3.012, p = 0.004), physical stress as precipitating factors (HR 1.882, 1.256-2.822, p = 0.012), history of depression (HR 1.622, 1.085-2.425, p = 0.009) and increased age (HR 1.059, 1.037-1.081, p < 0.001) after multivariate analysis. Beta-blockers and ACE inhibitors at discharge were not significant predictors. There were 24 (9.1%) recurrences during follow-up, but there were no significant differences in medical therapy compared to patients without recurrence.


The high mortality rate is related to non-cardiac co-morbidities such as cancer. Additional determinants include physical stressors, increased age, and history of depression. Use of beta-blockers and ACE inhibitors did not affect development, prognosis or recurrence.


Mortality; Prognosis; Recurrence; Takotsubo syndrome

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