Long-Term Prognosis of Patients With Takotsubo Syndrome

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 Bossone; Thomas 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; Leonarda Galiuto; Filippo Crea; 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

doi:10.1016/j.jacc.2018.06.016

Long-Term Prognosis of Patients With Takotsubo Syndrome

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 Bossone, Thomas Münzel, Maike KnorrSusanne 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, Leonarda Galiuto, Filippo Crea, 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

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Abstract

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 language	English
Pages (from-to)	874-882
Number of pages	9
Journal	Journal of the American College of Cardiology
Volume	72
DOIs	https://doi.org/10.1016/j.jacc.2018.06.016
Publication status	Published - 2018

Keywords

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

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10.1016/j.jacc.2018.06.016

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Ghadri, J. R., Kato, K., Cammann, V. L., Gili, S., Jurisic, S., Di Vece, D., Candreva, A., Ding, K. J., Micek, J., Szawan, K. A., Bacchi, B., Bianchi, R., Levinson, R. A., Wischnewsky, M., Seifert, B., Schlossbauer, S. A., Citro, R., Bossone, E., Münzel, T., ... Templin, C. (2018). Long-Term Prognosis of Patients With Takotsubo Syndrome. Journal of the American College of Cardiology, 72, 874-882. https://doi.org/10.1016/j.jacc.2018.06.016

@article{bbb96f3700e34278a5c9939c0890b3c4,

title = "Long-Term Prognosis of Patients With Takotsubo Syndrome",

abstract = "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)",

keywords = "Cardiology and Cardiovascular Medicine, Takotsubo syndrome, acute coronary syndrome, broken heart syndrome, classification, outcome, stress factor, Cardiology and Cardiovascular Medicine, Takotsubo syndrome, acute coronary syndrome, broken heart syndrome, classification, outcome, stress factor",

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

year = "2018",

doi = "10.1016/j.jacc.2018.06.016",

language = "English",

volume = "72",

pages = "874--882",

journal = "Journal of the American College of Cardiology",

issn = "0735-1097",

publisher = "Attuale:ELSEVIER SCIENCE INC, 360 PARK AVE SOUTH, NEW YORK, USA, NY, 10010-1710 W B Saunders Company:Fulfillment Department, The Curtis Center, Independence Square West:Philadelphia, PA 19106:(800)654-2452, (215)238-7800, EMAIL: [email protected], INTERNET: http://elsevierhealth.com, Fax: (215)238-6445",

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Ghadri, JR, Kato, K, Cammann, VL, Gili, S, Jurisic, S, Di Vece, D, Candreva, A, Ding, KJ, Micek, J, Szawan, KA, Bacchi, B, Bianchi, R, Levinson, RA, Wischnewsky, M, Seifert, B, Schlossbauer, SA, Citro, R, Bossone, E, Münzel, T, Knorr, M, Heiner, S, D'Ascenzo, F, Franke, J, Sarcon, A, Napp, LC, Jaguszewski, M, Noutsias, M, Katus, HA, Burgdorf, C, Schunkert, H, Thiele, H, Bauersachs, J, Tschöpe, C, Pieske, BM, Rajan, L, Michels, G, Pfister, R, Cuneo, A, Jacobshagen, C, Hasenfuß, G, Karakas, M, Koenig, W, Rottbauer, W, Said, SM, Braun-Dullaeus, RC, Banning, A, Cuculi, F, Kobza, R, Fischer, TA, Vasankari, T, Airaksinen, KEJ, Opolski, G, Dworakowski, R, Maccarthy, P, Kaiser, C, Osswald, S, Galiuto, L, Crea, F, Dichtl, W, Empen, K, Felix, SB, Delmas, C, Lairez, O, El-Battrawy, I, Akin, I, Borggrefe, M, Horowitz, J, Kozel, M, Tousek, P, Widimský, P, Gilyarova, E, Shilova, A, Gilyarov, M, Winchester, DE, Ukena, C, Bax, JJ, Prasad, A, Böhm, M, Lüscher, TF, Ruschitzka, F & Templin, C 2018, 'Long-Term Prognosis of Patients With Takotsubo Syndrome', Journal of the American College of Cardiology, vol. 72, pp. 874-882. https://doi.org/10.1016/j.jacc.2018.06.016

TY - JOUR

T1 - Long-Term Prognosis of Patients With Takotsubo Syndrome

AU - Ghadri, Jelena R.

AU - Kato, Ken

AU - Cammann, Victoria L.

AU - Gili, Sebastiano

AU - Jurisic, Stjepan

AU - Di Vece, Davide

AU - Candreva, Alessandro

AU - Ding, Katharina J.

AU - Micek, Jozef

AU - Szawan, Konrad A.

AU - Bacchi, Beatrice

AU - Bianchi, Rahel

AU - Levinson, Rena A.

AU - Wischnewsky, Manfred

AU - Seifert, Burkhardt

AU - Schlossbauer, Susanne A.

AU - Citro, Rodolfo

AU - Bossone, Eduardo

AU - Münzel, Thomas

AU - Knorr, Maike

AU - Heiner, Susanne

AU - D'Ascenzo, Fabrizio

AU - Franke, Jennifer

AU - Sarcon, Annahita

AU - Napp, L. Christian

AU - Jaguszewski, Milosz

AU - Noutsias, Michel

AU - Katus, Hugo A.

AU - Burgdorf, Christof

AU - Schunkert, Heribert

AU - Thiele, Holger

AU - Bauersachs, Johann

AU - Tschöpe, Carsten

AU - Pieske, Burkert M.

AU - Rajan, Lawrence

AU - Michels, Guido

AU - Pfister, Roman

AU - Cuneo, Alessandro

AU - Jacobshagen, Claudius

AU - Hasenfuß, Gerd

AU - Karakas, Mahir

AU - Koenig, Wolfgang

AU - Rottbauer, Wolfgang

AU - Said, Samir M.

AU - Braun-Dullaeus, Ruediger C.

AU - Banning, Adrian

AU - Cuculi, Florim

AU - Kobza, Richard

AU - Fischer, Thomas A.

AU - Vasankari, Tuija

AU - Airaksinen, K.E. Juhani

AU - Opolski, Grzegorz

AU - Dworakowski, Rafal

AU - Maccarthy, Philip

AU - Kaiser, Christoph

AU - Osswald, Stefan

AU - Galiuto, Leonarda

AU - Crea, Filippo

AU - Dichtl, Wolfgang

AU - Empen, Klaus

AU - Felix, Stephan B.

AU - Delmas, Clément

AU - Lairez, Olivier

AU - El-Battrawy, Ibrahim

AU - Akin, Ibrahim

AU - Borggrefe, Martin

AU - Horowitz, John

AU - Kozel, Martin

AU - Tousek, Petr

AU - Widimský, Petr

AU - Gilyarova, Ekaterina

AU - Shilova, Alexandra

AU - Gilyarov, Mikhail

AU - Winchester, David E.

AU - Ukena, Christian

AU - Bax, Jeroen J.

AU - Prasad, Abhiram

AU - Böhm, Michael

AU - Lüscher, Thomas F.

AU - Ruschitzka, Frank

AU - Templin, Christian

PY - 2018

Y1 - 2018

N2 - 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)

AB - 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)

KW - Cardiology and Cardiovascular Medicine

KW - Takotsubo syndrome

KW - acute coronary syndrome

KW - broken heart syndrome

KW - classification

KW - outcome

KW - stress factor

KW - Cardiology and Cardiovascular Medicine

KW - Takotsubo syndrome

KW - acute coronary syndrome

KW - broken heart syndrome

KW - classification

KW - outcome

KW - stress factor

UR - http://hdl.handle.net/10807/126515

UR - http://www.elsevier.com/locate/jacc

U2 - 10.1016/j.jacc.2018.06.016

DO - 10.1016/j.jacc.2018.06.016

M3 - Article

SN - 0735-1097

VL - 72

SP - 874

EP - 882

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

ER -

Long-Term Prognosis of Patients With Takotsubo Syndrome

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