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Heart Fail Rev. 2019 Feb 26. doi: 10.1007/s10741-019-09773-6. [Epub ahead of print]

Malignancies and outcome in Takotsubo syndrome: a meta-analysis study on cancer and stress cardiomyopathy.

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Department of Medical and Surgery Sciences, University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy.
Department of Medical and Surgery Sciences, University of Foggia, Viale Pinto n.1, 71122, Foggia, Italy.
Cardiology Department, San Paolo Hospital, Bari, Italy.
Ospedali Riuniti University Hospital, Foggia, Italy.
Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck, University Heart Center Lübeck, Lübeck, Germany.
GVM Care and Research, Santa Maria Hospital, Bari, Italy.
Department of Cardiology, Ospedale Bonomo Hospital, Andria, BT, Italy.


Takotsubo syndrome (TTS) can be induced by a large variety of physical/emotional triggers; several cases, however, are related to either an overt or occult malignancy, as shown in retrospective studies and case reports. The aim of this study was therefore to evaluate the clinical outcome of patients with TTS and cancer in a meta-analysis study. In June 2018, a Pubmed systematic research was conducted for studies assessing outcome in patients with TTS and cancer. We assessed Mantel-Haenszel pooled estimates of risk ratios (RRs) and 95% confidence intervals (CIs) for adverse events at follow-up. After paper retrieval, four studies were included in the meta-analysis, with a total of 123,563 patients. The prevalence of current or previous malignancy among patients admitted with TTS was 6.7% (8258 patients). When compared to control patients, patients with cancer showed an increased risk of clinical events (RR 3.24, 95% CI 3.04-3.45, p < 0.01). The risk of in-hospital events was significantly higher in the cancer group (RR 2.08 95% CI, 1.50-2.87, p < 0.01) and was mainly due to higher need for respiratory support (RR 1.67, 95% CI, 1.58-1.77, p < 0.01). The risk of adverse events at follow-up was also higher in the cancer group (RR 3.30, 95% CI 3.09-3.51, p < 0.01). Cancer, either history or active, is associated with an increased risk of adverse events in TTS.


Cancer; Malignancy; Meta-analysis; Prognosis; Stress cardiomyopathy; Takotsubo syndrome


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