Long-Term Prognosis of Patients With Takotsubo Syndrome

Leonarda Galiuto, Filippo Crea, Jelena R. Ghadri, Ken Kato, Victoria L. Cammann, Sebastiano Gili, Stjepan Jurisic, Davide Di Vece, Alessandro Candreva, Katharina J. Ding, Jozef Micek, Konrad A. Szawan, Beatrice Bacchi, Rahel Bianchi, Rena A. Levinson, Manfred Wischnewsky, Burkhardt Seifert, Susanne A. Schlossbauer, Rodolfo Citro, Eduardo BossoneThomas Münzel, Maike Knorr, Susanne Heiner, Fabrizio D'Ascenzo, Jennifer Franke, Annahita Sarcon, L. Christian Napp, Milosz Jaguszewski, Michel Noutsias, Hugo A. Katus, Christof Burgdorf, Heribert Schunkert, Holger Thiele, Johann Bauersachs, Carsten Tschöpe, Burkert M. Pieske, Lawrence Rajan, Guido Michels, Roman Pfister, Alessandro Cuneo, Claudius Jacobshagen, Gerd Hasenfuß, Mahir Karakas, Wolfgang Koenig, Wolfgang Rottbauer, Samir M. Said, Ruediger C. Braun-Dullaeus, Adrian Banning, Florim Cuculi, Richard Kobza, Thomas A. Fischer, Tuija Vasankari, K.E. Juhani Airaksinen, Grzegorz Opolski, Rafal Dworakowski, Philip Maccarthy, Christoph Kaiser, Stefan Osswald, Wolfgang Dichtl, Klaus Empen, Stephan B. Felix, Clément Delmas, Olivier Lairez, Ibrahim El-Battrawy, Ibrahim Akin, Martin Borggrefe, John Horowitz, Martin Kozel, Petr Tousek, Petr Widimský, Ekaterina Gilyarova, Alexandra Shilova, Mikhail Gilyarov, David E. Winchester, Christian Ukena, Jeroen J. Bax, Abhiram Prasad, Michael Böhm, Thomas F. Lüscher, Frank Ruschitzka, Christian Templin

Research output: Contribution to journalArticle

98 Citations (Scopus)


Background: Prognosis of Takotsubo syndrome (TTS) remains controversial due to scarcity of available data. Additionally, the effect of the triggering factors remains elusive. Objectives: This study compared prognosis between TTS and acute coronary syndrome (ACS) patients and investigated short- and long-term outcomes in TTS based on different triggers. Methods: Patients with TTS were enrolled from the International Takotsubo Registry. Long-term mortality of patients with TTS was compared to an age- and sex-matched cohort of patients with ACS. In addition, short- and long-term outcomes were compared between different groups according to triggering conditions. Results: Overall, TTS patients had a comparable long-term mortality risk with ACS patients. Of 1,613 TTS patients, an emotional trigger was detected in 485 patients (30%). Of 630 patients (39%) related to physical triggers, 98 patients (6%) had acute neurologic disorders, while in the other 532 patients (33%), physical activities, medical conditions, or procedures were the triggering conditions. The remaining 498 patients (31%) had no identifiable trigger. TTS patients related to physical stress showed higher mortality rates than ACS patients during long-term follow-up, whereas patients related to emotional stress had better outcomes compared with ACS patients. Conclusions: Overall, TTS patients had long-term outcomes comparable to age- and sex-matched ACS patients. Also, we demonstrated that TTS can either be benign or a life-threating condition depending on the inciting stress factor. We propose a new classification based on triggers, which can serve as a clinical tool to predict short- and long-term outcomes of TTS. (International Takotsubo Registry [InterTAK Registry]; NCT01947621)
Original languageEnglish
Pages (from-to)874-882
Number of pages9
Publication statusPublished - 2018


  • Cardiology and Cardiovascular Medicine
  • Takotsubo syndrome
  • acute coronary syndrome
  • broken heart syndrome
  • classification
  • outcome
  • stress factor


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