Long‐term excess mortality in takotsubo cardiomyopathy: predictors, causes and clinical consequences

Abstract

Aims Despite increasing research efforts, the prognostic consequences of takotsubo cardiomyopathy (TTC) remain largely unknown. The aim of this study was therefore to compare the long‐term mortality rate of TTC patients with high‐risk patients presenting with ST‐segment elevation myocardial infarction (STEMI). Methods and results A total of 286 patients with TTC were matched for age and gender with 286 STEMI patients. Outcome was obtained with a standardized telephone follow‐up. The primary analysis determined long‐term mortality. A secondary analysis was performed evaluating 28‐day and 1‐year mortality. Follow‐up was available for 96% of patients after a mean of 3.8 ± 2.5 years. In TTC patients, long‐term mortality was significantly higher compared with the matched STEMI cohort [24.7% vs. 15.1%, hazard ratio (HR) 1.58, 95% confidence interval (CI) 1.07–2.33; P = 0.02]. There was no significant difference in the rates of 28‐day (5.5% vs. 5.7%, HR 0.96, 95% CI 0.47–1.94; P = 0.91) and 1‐year mortality (12.5% vs. 9%, HR 1.42, 95% CI 0.85–2.38; P = 0.18). In multivariable regression analysis, male sex, a high Killip class on admission, and diabetes mellitus were identified as independent predictors of mortality in TTC patients. A risk score consisting of these factors showed a higher mortality with an increasing number of risk factors. Conclusion Mortality rates in TTC patients are higher than previously expected and long‐term mortality exceeded that of patients with STEMI. A simple risk score may provide an approach to identify high‐risk patients and predict clinical prognosis.

Left Ventricular Thrombi in Takotsubo Syndrome: Incidence, Predictors, and Management: Results From the GEIST (German Italian Stress Cardiomyopathy) Registry

“…Although TTS patients have an increased risk of mortality when compared with ST‐segment elevation myocardial infarction patients,37 survival rates of patients with LV thrombi were similar to those without LV thrombi after 3 years of follow‐up. Therefore, a routine cardiological follow‐up similar to those TTS patients without LV thrombi is reasonable.…”

“…Angiotensin‐converting enzyme inhibitors or angiotensin II receptor blockers could have some benefit in term of improved survival at 1 year 3. β‐Blockers showed no effect on survival and recurrence rate,3, 4, 5, 6, 7, 8, 9, 10, 11, 12, 13, 14, 15, 16, 17, 18, 19, 20, 21, 22, 23, 24, 25, 26, 27, 28, 29, 30, 31, 32, 33, 34, 35, 36, 37, 38 whereas calcium antagonists could be used if coronary vasospasm has been proven during coronary angiogram or with acetylcholine test 32…”

Alterations in Cardiac Deformation, Timing of Contraction and Relaxation, and Early Myocardial Fibrosis Accompany the Apparent Recovery of Acute Stress-Induced (Takotsubo) Cardiomyopathy: An End to the Concept of Transience

“…These objective abnormalities indicate that complete recovery in these patients may not occur as rapidly as previously thought and together with the persistent symptoms that we consistently observed during the clinical followup of these patients prompted us to re-evaluate cardiac mechanics. A longer convalescent period or an incomplete recovery after an acute takotsubo episode would better explain the recent registries' data which place the long-term prognosis of takotsubo at a comparable level to that of MI 2,3,22 . Further, the apical ballooning subtype of takotsubo studied by us here has been recently shown to have the least favorable outcome of all takotsubo variants 23 .…”

Long‐term excess mortality in Takotsubo syndrome: is it justified to charge Takotsubo for the excess long‐term mortality?: Reply

“…1 Apart from our investigation, two other study groups have published long-term outcome data in large TTC populations recently. 2,3 A Swedish registry study compared long-term mortality between 302 TTC patients and a control group of patients with acute myocardial infarction and found a similar risk of death.…”