Clinical Features and Outcomes of Patients With Malignancy and Takotsubo Syndrome: Observations From the International Takotsubo Registry

Cammann, Victoria L.; Sarcon, Annahita; Ding, Katharina J.; Seifert, Burkhardt; Kato, Ken; Vece, Davide Di; Szawan, Konrad A.; Gili, Sebastiano; Jurisic, Stjepan; Bacchi, Beatrice; Micek, Jozef; Frangieh, Antonio H.; Napp, L. Christian; Jaguszewski, Miłosz; Bossone, Eduardo; Citro, Rodolfo; D’Ascenzo, Fabrizio; Franke, Jennifer; Noutsias, Michel; Knorr, Maike; Heiner, Susanne; Burgdorf, Christof; Köenig, Wolfgang; Thiele, Holger; Tschöpe, Carsten; Rajan, Lawrence; Michels, Guido; Pfister, Roman; Cuneo, Alessandro; Jacobshagen, Claudius; Karakas, Mahir; Banning, Adrian P.; Cuculi, Florim; Kobza, Richard; Fischer, Thomas; Vasankari, Tuija; Airaksinen, Juhani; Dworakowski, Rafał; Kaiser, Christoph; Oßwald, Stefan; Galiuto, Leonarda; Dichtl, Wolfgang; Delmas, Clément; Lairez, Olivier; Horowitz, John D.; Kozel, Martin; Widimský, Petr; Toušek, Petr; Winchester, David E.; Gilyarova, Ekaterina; Shilova, Alexandra; Gilyarov, Mikhail; El‐Battrawy, Ibrahim; Akın, İbrahim; Ukena, Christian; Bauersachs, Johann; Pieske, Burkert; Hasenfuß, Gerd; Rottbauer, Wolfgang; Braun‐Dullaeus, Ruediger C.; Opolski, Grzegorz; MacCarthy, Philip; Felix, Stephan B.; Borggrefe, Martin; Mario, Carlo Di; Crea, Filippo; Katus, Hugo A.; Schunkert, Heribert; Münzel, Thomas; Böhm, Michael; Bax, Jeroen J.; Prasad, Abhiram; Shinbane, Jerold S.; Lüscher, Thomas F.; Ruschitzka, Frank; Ghadri, Jelena R.; Templin, Christian

doi:10.1161/jaha.118.010881

Cited by 71 publications

(86 citation statements)

References 24 publications

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“…They show that TTS in association with A/Ca more often presents as secondary TTS,with associate clinical impact includingsignificantly increased in-hospital MACE rates [17]. Indeed, Cammann et al [8] have recently reported, within the InterTAK cohort, increased in-hospital death rates in patients with A/Ca and TTS. They also show that patients with A/Ca have greater risks not only of late all-cause mortality, but (2) and (3) point strongly to some substantial and ongoing interaction between the presence of cancer and the probability of CVS complications (shortand long-term) of TTS.…”

Section: Discussionmentioning

confidence: 99%

“…Recently, reports have been made from several groups, including the International InterTAK collaboration, that TTS is often associated with presence of internal malignancy at the time of presentation [8][9][10]. Furthermore, there is a suggestion that TTS represents a basis for increased risk of later emergence of malignancies and for fatal outcomes from those malignancies [11,12].…”

Section: Introductionmentioning

confidence: 99%

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Antecedent cancer in Takotsubo syndrome predicts both cardiovascular and long-term mortality

et al. 2019

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Background: Takotsubo syndrome (TTS), primarily an acute myocardial inflammatory condition engendered by catecholamine exposure, is associated with similar long-term mortality rates to those of patients with acute myocardial infarction. However, there is increasing evidence of a nexus between TTS and underlying malignancies:many patients have antecedent cancer (A/Ca), while incremental risk of late cancer-related death has also been reported. Purpose: To evaluate potential interactions between A/Ca among TTS patients and both early and late clinical course.Methods: Three hundred forty-six consecutive TTS patients [aged 69 ± 13 (SD) years, males: 8.2%] were prospectively followed up for a median duration of 4.1 (IQR 2.2-6.4) years. Associations between A/Ca and severity of acute attacks, in-hospital complications and long-term death rates were sought utilising univariate analyses followed by multiple logistic regression analysis. Results: A/Ca (present in 16.8% of patients) was associated with (i) greater elevation of hs-CRP and NT-proBNP concentrations (p = 0.01 and 0.04, respectively), (ii) more complicated in-hospital clinical course, with major adverse cardiac events (MACE) in 30.9% of patients, compared to 18.2% in non-A/Ca patients (p = 0.04). Long-term all-cause mortality rate was also greater [hazard ratio (HR) = 2.4, p = 0.0001] in A/Ca patients, with an excess cardiovascular (CVS) fatality rate (HR = 3.1, p = 0.001). On multivariate analysis, male gender, peak plasma concentrations of normetanephrine and hs-CRP, early arrhythmias and development of shock, but not A/Ca per se, were all independently associated with increased long-term mortality rate. Furthermore, patients discharged on β-adrenoceptor antagonists (βBl) or angiotensin converting enzyme inhibitors/ angiotensin receptor blockers (ACEi/ARB) had lower long-term mortality rates (β = − 0.2, p = 0.01; β = − 0.14, p = 0.05, respectively). Conclusions: (1) A/Ca is associated with greater clinical severity of initial TTS attacks and substantially greater longterm CVS-related as well as all-cause mortality.(2) Post-discharge therapy with either βBl or ACEi/ARB is associated with reductions in long-term mortality rates. Overall, the current data suggest operation of substantial interactions between neoplasia and TTS, both at the level of pathogenesis and of outcomes.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Antecedent cancer in Takotsubo syndrome predicts both cardiovascular and long-term mortality

et al. 2019

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“…12 One of the hypothesis is that cancer and TTS share similar triggering mechanisms, which consist in activation of the sympathetic nervous system. 8,13 Therefore, TTS patients with cancer should be considered a high-risk subgroup with respect to their increased mortality rate.…”

Section: Discussionmentioning

confidence: 99%

“…Although most patients with TTS experience complete cardiac function recovery, the risk of complications is similar to that in patients with acute coronary syndrome. 13 Patients who survive an acute episode typically recover systolic function within one to four weeks. 1,3 Our patient recovered the systolic function within two weeks.…”

Section: Discussionmentioning

confidence: 99%

Takotsubo Syndrome Induced by Brachytherapy in a Patient with Endocervical Adenocarcinoma.

Vieira

Ribeiro

Lima

et al. 2020

Preprint

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Background: Takotsubo syndrome (TTS), also known as stress cardiomyopathy, apical ballooning syndrome and broken heart syndrome, is characterized by acute-onset chest pain, electrocardiographic (ECG) abnormalities and reversible left ventricular (LV) disfunction in the absence of a culprit obstructive lesion in the coronary arteries; therefore, myocardial infarction is the most important differential diagnosis. Usually induced by emotional/physical stress, its treatment consists in hemodynamic support until complete and spontaneous recovery occurs, which is generally achieved within a few days to weeks. Cervical malignancies are an important public health issue in low/middle-income countries and, in the setting of locally advanced disease, concurrent chemoradiation followed by brachytherapy is considered the standard treatment, harboring curative potential. Case report: We report a case of a 38-year-old woman who underwent concurrent chemoradiotherapy and developed cardiopulmonary arrest in ventricular fibrillation during a brachytherapy session. Complementary tests disclosed altered EKG and cardiac biomarkers, no evidence of coronary artery obstruction, as well as LV disfunction consistent with TTS on echocardiogram and cardiac MRI. After few days of supportive therapy, complete recovery of heart function was observed. Conclusion: considering that community clinicians might be unfamiliar with TTS, this condition is likely to be underdiagnosed. Especially for cancer patients, who usually experience intense emotional/physical stress intrinsically associated with their diagnosis and aggressive treatments, considering TTS as a differential diagnosis is warranted. Intracavitary brachytherapy procedure may represent a trigger for TTS.

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“…Analysis of the multicenter GEIST (German Italian Stress Cardiomyopathy) Registry data failed to identify any independent predictors of TTS recurrence [28]. Presence of malignancy has been shown to be associated with higher risk of TTS in numerous studies [29][30][31], and there are numerous reports of TTS associated with chemotherapy or immunotherapy [32][33][34][35][36]. It is plausible that interruption in chemotherapy after initial episode of TTS may play a role in explaining the lack of difference in TTS recurrence rate in those with malignancy.…”

Section: Discussionmentioning

confidence: 99%

Thirty-Day Readmission Rates After Takotsubo Syndrome With or Without Malignancy: A Nationwide Readmissions Database Analysis

Jang

Yeo

Jonas

et al. 2020

Preprint

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Background: Association of malignancy with readmission after TTS hospitalization has not been fully described. We sought to examine the rates, cause and cost of 30-day readmissions and 30-day all-cause mortality of Takotsubo syndrome (TTS) patients with or without malignancy. Methods: The Nationwide Readmissions Databases from 2010 to 2014 were queried to identify and compare baseline characteristics and outcomes of patients hospitalized for TTS with and without malignancy. Results: We identified 61,588 index hospitalizations for TTS. TTS patients with malignancy were older (70.6 ± 0.2 vs. 66.1 ± 0.1, p < 0.001), and the overall burden of comorbidities was higher than in those without malignancy. TTS patients with malignancy had significantly higher 30-day readmission rates than those without malignancy (15.9% vs. 11.0%; odds ratio [OR], 1.35; 95% confidence interval [CI], 1.18 - 1.56). Majority (75.5%) of the etiologies for readmissions were non-cardiac, with infection being most common (20.1%). The 30-day readmission rate due to the recurrent TTS was similar in both groups (0.4% and 0.5%, respectively; p = 0.47). Importantly, 30-day all-cause mortality was higher in TTS with vs. without malignancy (4.8% vs 2.5%; OR, 1.62; 95% CI, 1.25 - 2.10). The total costs (index admission + readmission) were higher by 25% (p < 0.001) in TTS patients with malignancy vs. without malignancy. Conclusions: In patients hospitalized with TTS, the presence of malignancy was associated with increased risk of 30-day readmission, mostly attributable to non-cardiac etiologies. Importantly, the 30-day all-cause mortality and cost were also significantly higher. These findings highlight the importance of optimization of treatment and follow up in patients with malignancy after hospitalizations for TTS.

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Clinical Features and Outcomes of Patients With Malignancy and Takotsubo Syndrome: Observations From the International Takotsubo Registry

Cited by 71 publications

References 24 publications

Antecedent cancer in Takotsubo syndrome predicts both cardiovascular and long-term mortality

Antecedent cancer in Takotsubo syndrome predicts both cardiovascular and long-term mortality

Takotsubo Syndrome Induced by Brachytherapy in a Patient with Endocervical Adenocarcinoma.

Thirty-Day Readmission Rates After Takotsubo Syndrome With or Without Malignancy: A Nationwide Readmissions Database Analysis

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