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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.

Author information

1
Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA; Division of Cardiology, Kosin University Gospel Hospital, Busan, Republic of Korea.
2
Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA.
3
Division of Biomedical Statistics and Informatics, Mayo Clinic, Rochester, MN, USA.
4
Division of Nephrology and Hypertension, Mayo Clinic, Rochester, MN, USA.
5
Department of Cardiovascular Disease, Mayo Clinic, Rochester, MN, USA. Electronic address: Lerman.Amir@mayo.edu.

Abstract

BACKGROUND:

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.

METHODS:

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.

RESULTS:

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.

CONCLUSION:

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.

KEYWORDS:

Mortality; Prognosis; Recurrence; Takotsubo syndrome

PMID:
29957259
DOI:
10.1016/j.ijcard.2018.04.139
[Indexed for MEDLINE]

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