Ethnic comparison in takotsubo syndrome: novel insights from the International Takotsubo Registry

Abstract

Background Ethnic disparities have been reported in cardiovascular disease. However, ethnic disparities in takotsubo syndrome (TTS) remain elusive. This study assessed differences in clinical characteristics between Japanese and European TTS patients and determined the impact of ethnicity on in-hospital outcomes. Methods TTS patients in Japan were enrolled from 10 hospitals and TTS patients in Europe were enrolled from 32 hospitals participating in the International Takotsubo Registry. Clinical characteristics and in-hospital outcomes were compared between Japanese and European patients. Results A total of 503 Japanese and 1670 European patients were included. Japanese patients were older (72.6 ± 11.4 years vs. 68.0 ± 12.0 years; p < 0.001) and more likely to be male (18.5 vs. 8.4%; p < 0.001) than European TTS patients. Physical triggering factors were more common (45.5 vs. 32.0%; p < 0.001), and emotional triggers less common (17.5 vs. 31.5%; p < 0.001), in Japanese patients than in European patients. Japanese patients were more likely to experience cardiogenic shock during the acute phase (15.5 vs. 9.0%; p < 0.001) and had a higher in-hospital mortality (8.2 vs. 3.2%; p < 0.001). However, ethnicity itself did not appear to have an impact on in-hospital mortality. Machine learning approach revealed that the presence of physical stressors was the most important prognostic factor in both Japanese and European TTS patients. Conclusion Differences in clinical characteristics and in-hospital outcomes between Japanese and European TTS patients exist. Ethnicity does not impact the outcome in TTS patients. The worse in-hospital outcome in Japanese patients, is mainly driven by the higher prevalence of physical triggers. Trial Registration URL: https://www.clinicaltrials.gov; Unique Identifier: NCT01947621.

Ventricular Tachycardia in Patients With Takotsubo Cardiomyopathy: Prevalence, Predictors, and Associated In-Hospital Adverse Events

“…complications [18]. Moreover, a study that examined ethnic disparities in TCM using data from the International Takotsubo Registry found that Japanese patients had higher in-hospital mortality and required more interventions, such as vasopressor or IABP use [19] This is consistent with our findings that Asian or Pacific Islander patients experienced higher mortality rates. With the limited data and analyses on the ethnic disparities that exist in TCM patients, further studies are needed to examine the reasons behind higher mortality rates in certain races compared to others.…”

Takotsubo Syndrome in Black Americans: Insights From the National Inpatient Sample

“… 13 , 30 In terms of in-hospital complications, Black patients presented with higher rates of cerebrovascular accident, acute kidney injury, and inpatient mortality and had longer hospital stays than their White counterparts, 18 , 21 suggesting that race may play a role in the outcomes of Black patients with TTS; this finding is in contrast with those of previous studies. 18 , 19 , 31 …”

Takotsubo syndrome: unravelling the enigma of the broken heart syndrome?—a narrative review

“…However, it is important to note that ethnicity itself does not influence the prognosis for TTS patients. The poorer in-hospital outcomes among Japanese patients are primarily attributed to the higher incidence of physical triggers ( 15 ). African-American TTS patients have been reported to have more frequent in-hospital complications, such as respiratory failure and stroke and require mechanical ventilation, as compared with Caucasians and Hispanics ( 16 ).…”