Age-Related Variations in Takotsubo Syndrome

Victoria L. Cammann; Konrad A. Szawan; Barbara E. Stähli; Ken Kato; Monika Budnik; Manfred Wischnewsky; Sara Dreiding; Rena A. Levinson; Davide Di Vece; Sebastiano Gili; Rodolfo Citro; Eduardo Bossone; Michael Neuhaus; Jennifer Franke; Benjamin Meder; Miłosz Jaguszewski; Michel Noutsias; Maike Knorr; Susanne Heiner; Fabrizio D'Ascenzo; Wolfgang Dichtl; Christof Burgdorf; Behrouz Kherad; Carsten Tschöpe; Annahita Sarcon; Jerold Shinbane; Lawrence Rajan; Guido Michels; Roman Pfister; Alessandro Cuneo; Claudius Jacobshagen; Mahir Karakas; Wolfgang Koenig; Alexander Pott; Philippe Meyer; Marco Roffi; Adrian Banning; Mathias Wolfrum; Florim Cuculi; Richard Kobza; Thomas A. Fischer; Tuija Vasankari; K. E.Juhani Airaksinen; L. Christian Napp; Rafal Dworakowski; Philip MacCarthy; Christoph Kaiser; Stefan Osswald; Leonarda Galiuto; Christina Chan; Paul Bridgman; Daniel Beug; Clément Delmas; Olivier Lairez; Ekaterina Gilyarova; Alexandra Shilova; Mikhail Gilyarov; Ibrahim El-Battrawy; Ibrahim Akin; Karolina Poledniková; Petr Toušek; David E. Winchester; Jan Galuszka; Christian Ukena; Gregor Poglajen; Pedro Carrilho-Ferreira; Christian Hauck; Carla Paolini; Claudio Bilato; Yoshio Kobayashi; Toshihiro Shoji; Iwao Ishibashi; Masayuki Takahara; Toshiharu Himi; Jehangir Din; Ali Al-Shammari; Abhiram Prasad; Charanjit S. Rihal; Kan Liu; P. Christian Schulze; Matteo Bianco; Lucas Jörg; Hans Rickli; Gonçalo Pestana; Thanh H. Nguyen; Michael Böhm; Lars S. Maier; Fausto J. Pinto; Petr Widimský; Stephan B. Felix; Ruediger C. Braun-Dullaeus; Wolfgang Rottbauer; Gerd Hasenfuß; Burkert M. Pieske; Heribert Schunkert; Martin Borggrefe; Holger Thiele; Johann Bauersachs; Hugo A. Katus; John D. Horowitz; Carlo Di Mario; Thomas Münzel; Filippo Crea; Jeroen J. Bax; Thomas F. Lüscher; Frank Ruschitzka; Jelena R. Ghadri; Grzegorz Opolski; Christian Templin

doi:10.1016/j.jacc.2020.02.057

Age-Related Variations in Takotsubo Syndrome

Victoria L. Cammann, Konrad A. Szawan, Barbara E. Stähli, Ken Kato, Monika Budnik, Manfred Wischnewsky, Sara Dreiding, Rena A. Levinson, Davide Di Vece, Sebastiano Gili, Rodolfo Citro, Eduardo Bossone, Michael Neuhaus, Jennifer Franke, Benjamin Meder, Miłosz Jaguszewski, Michel Noutsias, Maike Knorr, Susanne Heiner, Fabrizio D'AscenzoWolfgang Dichtl, Christof Burgdorf, Behrouz Kherad, Carsten Tschöpe, Annahita Sarcon, Jerold Shinbane, Lawrence Rajan, Guido Michels, Roman Pfister, Alessandro Cuneo, Claudius Jacobshagen, Mahir Karakas, Wolfgang Koenig, Alexander Pott, Philippe Meyer, Marco Roffi, Adrian Banning, Mathias Wolfrum, Florim Cuculi, Richard Kobza, Thomas A. Fischer, Tuija Vasankari, K. E.Juhani Airaksinen, L. Christian Napp, Rafal Dworakowski, Philip MacCarthy, Christoph Kaiser, Stefan Osswald, Leonarda Galiuto, Christina Chan, Paul Bridgman, Daniel Beug, Clément Delmas, Olivier Lairez, Ekaterina Gilyarova, Alexandra Shilova, Mikhail Gilyarov, Ibrahim El-Battrawy, Ibrahim Akin, Karolina Poledniková, Petr Toušek, David E. Winchester, Jan Galuszka, Christian Ukena, Gregor Poglajen, Pedro Carrilho-Ferreira, Christian Hauck, Carla Paolini, Claudio Bilato, Yoshio Kobayashi, Toshihiro Shoji, Iwao Ishibashi, Masayuki Takahara, Toshiharu Himi, Jehangir Din, Ali Al-Shammari, Abhiram Prasad, Charanjit S. Rihal, Kan Liu, P. Christian Schulze, Matteo Bianco, Lucas Jörg, Hans Rickli, Gonçalo Pestana, Thanh H. Nguyen, Michael Böhm, Lars S. Maier, Fausto J. Pinto, Petr Widimský, Stephan B. Felix, Ruediger C. Braun-Dullaeus, Wolfgang Rottbauer, Gerd Hasenfuß, Burkert M. Pieske, Heribert Schunkert, Martin Borggrefe, Holger Thiele, Johann Bauersachs, Hugo A. Katus, John D. Horowitz, Carlo Di Mario, Thomas Münzel, Filippo Crea, Jeroen J. Bax, Thomas F. Lüscher, Frank Ruschitzka, Jelena R. Ghadri, Grzegorz Opolski, Christian Templin

Cardiovascular Medicine

Research output: Contribution to journal › Article › peer-review

6 Scopus citations

Abstract

Background: Takotsubo syndrome (TTS) occurs predominantly in post-menopausal women but is also found in younger patients. Objectives: This study aimed to investigate age-related differences in TTS. Methods: Patients diagnosed with TTS and enrolled in the International Takotsubo Registry between January 2011 and February 2017 were included in this analysis and were stratified by age (younger: ≤50 years, middle-age: 51 to 74 years, elderly: ≥75 years). Baseline characteristics, hospital course, as well as short- and long-term mortality were compared among groups. Results: Of 2,098 TTS patients, 242 (11.5%) patients were ≤50 years of age, 1,194 (56.9%) were 51 to 74 years of age, and 662 (31.6%) were ≥75 years of age. Younger patients were more often men (12.4% vs. 10.9% vs. 6.3%; p = 0.002) and had an increased prevalence of acute neurological (16.3% vs. 8.4% vs. 8.8%; p = 0.001) or psychiatric disorders (14.1% vs. 10.3% vs. 5.6%; p < 0.001) compared with middle-aged and elderly TTS patients. Furthermore, younger patients had more often cardiogenic shock (15.3% vs. 9.1% vs. 8.1%; p = 0.004) and had a numerically higher in-hospital mortality (6.6% vs. 3.6% vs. 5.1%; p = 0.07). At multivariable analysis, younger (odds ratio: 1.60; 95% confidence interval: 0.86 to 3.01; p = 0.14) and older age (odds ratio: 1.09; 95% confidence interval: 0.66 to 1.80; p = 0.75) were not independently associated with in-hospital mortality using the middle-aged group as a reference. There were no differences in 60-day mortality rates among groups. Conclusions: A substantial proportion of TTS patients are younger than 50 years of age. TTS is associated with severe complications requiring intensive care, particularly in younger patients.

Original language	English (US)
Pages (from-to)	1869-1877
Number of pages	9
Journal	Journal of the American College of Cardiology
Volume	75
Issue number	16
DOIs	https://doi.org/10.1016/j.jacc.2020.02.057
State	Published - Apr 28 2020

Keywords

Takotsubo syndrome
age
broken heart syndrome
outcome

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine

Access to Document

10.1016/j.jacc.2020.02.057

Cite this

Cammann, V. L., Szawan, K. A., Stähli, B. E., Kato, K., Budnik, M., Wischnewsky, M., Dreiding, S., Levinson, R. A., Di Vece, D., Gili, S., Citro, R., Bossone, E., Neuhaus, M., Franke, J., Meder, B., Jaguszewski, M., Noutsias, M., Knorr, M., Heiner, S., ... Templin, C. (2020). Age-Related Variations in Takotsubo Syndrome. Journal of the American College of Cardiology, 75(16), 1869-1877. https://doi.org/10.1016/j.jacc.2020.02.057

Cammann, VL, Szawan, KA, Stähli, BE, Kato, K, Budnik, M, Wischnewsky, M, Dreiding, S, Levinson, RA, Di Vece, D, Gili, S, Citro, R, Bossone, E, Neuhaus, M, Franke, J, Meder, B, Jaguszewski, M, Noutsias, M, Knorr, M, Heiner, S, D'Ascenzo, F, Dichtl, W, Burgdorf, C, Kherad, B, Tschöpe, C, Sarcon, A, Shinbane, J, Rajan, L, Michels, G, Pfister, R, Cuneo, A, Jacobshagen, C, Karakas, M, Koenig, W, Pott, A, Meyer, P, Roffi, M, Banning, A, Wolfrum, M, Cuculi, F, Kobza, R, Fischer, TA, Vasankari, T, Airaksinen, KEJ, Napp, LC, Dworakowski, R, MacCarthy, P, Kaiser, C, Osswald, S, Galiuto, L, Chan, C, Bridgman, P, Beug, D, Delmas, C, Lairez, O, Gilyarova, E, Shilova, A, Gilyarov, M, El-Battrawy, I, Akin, I, Poledniková, K, Toušek, P, Winchester, DE, Galuszka, J, Ukena, C, Poglajen, G, Carrilho-Ferreira, P, Hauck, C, Paolini, C, Bilato, C, Kobayashi, Y, Shoji, T, Ishibashi, I, Takahara, M, Himi, T, Din, J, Al-Shammari, A, Prasad, A, Rihal, CS, Liu, K, Schulze, PC, Bianco, M, Jörg, L, Rickli, H, Pestana, G, Nguyen, TH, Böhm, M, Maier, LS, Pinto, FJ, Widimský, P, Felix, SB, Braun-Dullaeus, RC, Rottbauer, W, Hasenfuß, G, Pieske, BM, Schunkert, H, Borggrefe, M, Thiele, H, Bauersachs, J, Katus, HA, Horowitz, JD, Di Mario, C, Münzel, T, Crea, F, Bax, JJ, Lüscher, TF, Ruschitzka, F, Ghadri, JR, Opolski, G & Templin, C 2020, 'Age-Related Variations in Takotsubo Syndrome', Journal of the American College of Cardiology, vol. 75, no. 16, pp. 1869-1877. https://doi.org/10.1016/j.jacc.2020.02.057

@article{85c9994253344e09a077afae76d6a9c6,

title = "Age-Related Variations in Takotsubo Syndrome",

abstract = "Background: Takotsubo syndrome (TTS) occurs predominantly in post-menopausal women but is also found in younger patients. Objectives: This study aimed to investigate age-related differences in TTS. Methods: Patients diagnosed with TTS and enrolled in the International Takotsubo Registry between January 2011 and February 2017 were included in this analysis and were stratified by age (younger: ≤50 years, middle-age: 51 to 74 years, elderly: ≥75 years). Baseline characteristics, hospital course, as well as short- and long-term mortality were compared among groups. Results: Of 2,098 TTS patients, 242 (11.5%) patients were ≤50 years of age, 1,194 (56.9%) were 51 to 74 years of age, and 662 (31.6%) were ≥75 years of age. Younger patients were more often men (12.4% vs. 10.9% vs. 6.3%; p = 0.002) and had an increased prevalence of acute neurological (16.3% vs. 8.4% vs. 8.8%; p = 0.001) or psychiatric disorders (14.1% vs. 10.3% vs. 5.6%; p < 0.001) compared with middle-aged and elderly TTS patients. Furthermore, younger patients had more often cardiogenic shock (15.3% vs. 9.1% vs. 8.1%; p = 0.004) and had a numerically higher in-hospital mortality (6.6% vs. 3.6% vs. 5.1%; p = 0.07). At multivariable analysis, younger (odds ratio: 1.60; 95% confidence interval: 0.86 to 3.01; p = 0.14) and older age (odds ratio: 1.09; 95% confidence interval: 0.66 to 1.80; p = 0.75) were not independently associated with in-hospital mortality using the middle-aged group as a reference. There were no differences in 60-day mortality rates among groups. Conclusions: A substantial proportion of TTS patients are younger than 50 years of age. TTS is associated with severe complications requiring intensive care, particularly in younger patients.",

keywords = "Takotsubo syndrome, age, broken heart syndrome, outcome",

author = "Cammann, {Victoria L.} and Szawan, {Konrad A.} and St{\"a}hli, {Barbara E.} and Ken Kato and Monika Budnik and Manfred Wischnewsky and Sara Dreiding and Levinson, {Rena A.} and {Di Vece}, Davide and Sebastiano Gili and Rodolfo Citro and Eduardo Bossone and Michael Neuhaus and Jennifer Franke and Benjamin Meder and Mi{\l}osz Jaguszewski and Michel Noutsias and Maike Knorr and Susanne Heiner and Fabrizio D'Ascenzo and Wolfgang Dichtl and Christof Burgdorf and Behrouz Kherad and Carsten Tsch{\"o}pe and Annahita Sarcon and Jerold Shinbane and Lawrence Rajan and Guido Michels and Roman Pfister and Alessandro Cuneo and Claudius Jacobshagen and Mahir Karakas and Wolfgang Koenig and Alexander Pott and Philippe Meyer and Marco Roffi and Adrian Banning and Mathias Wolfrum and Florim Cuculi and Richard Kobza and Fischer, {Thomas A.} and Tuija Vasankari and Airaksinen, {K. E.Juhani} and Napp, {L. Christian} and Rafal Dworakowski and Philip MacCarthy and Christoph Kaiser and Stefan Osswald and Leonarda Galiuto and Christina Chan and Paul Bridgman and Daniel Beug and Cl{\'e}ment Delmas and Olivier Lairez and Ekaterina Gilyarova and Alexandra Shilova and Mikhail Gilyarov and Ibrahim El-Battrawy and Ibrahim Akin and Karolina Polednikov{\'a} and Petr Tou{\v s}ek and Winchester, {David E.} and Jan Galuszka and Christian Ukena and Gregor Poglajen and Pedro Carrilho-Ferreira and Christian Hauck and Carla Paolini and Claudio Bilato and Yoshio Kobayashi and Toshihiro Shoji and Iwao Ishibashi and Masayuki Takahara and Toshiharu Himi and Jehangir Din and Ali Al-Shammari and Abhiram Prasad and Rihal, {Charanjit S.} and Kan Liu and Schulze, {P. Christian} and Matteo Bianco and Lucas J{\"o}rg and Hans Rickli and Gon{\c c}alo Pestana and Nguyen, {Thanh H.} and Michael B{\"o}hm and Maier, {Lars S.} and Pinto, {Fausto J.} and Petr Widimsk{\'y} and Felix, {Stephan B.} and Braun-Dullaeus, {Ruediger C.} and Wolfgang Rottbauer and Gerd Hasenfu{\ss} and Pieske, {Burkert M.} and Heribert Schunkert and Martin Borggrefe and Holger Thiele and Johann Bauersachs and Katus, {Hugo A.} and Horowitz, {John D.} and {Di Mario}, Carlo and Thomas M{\"u}nzel and Filippo Crea and Bax, {Jeroen J.} and L{\"u}scher, {Thomas F.} and Frank Ruschitzka and Ghadri, {Jelena R.} and Grzegorz Opolski and Christian Templin",

note = "Funding Information: The prevalence of cardiogenic shock and the need for intensive cardiac care treatment including catecholamine use and noninvasive and invasive ventilation was particularly high in younger TTS patients. These findings are supported by data obtained from a cohort of 114 TTS patients showing trends toward increased rates of mechanical ventilation and catecholamine use in patients ≤65 years of age (10). Although patients ≤50 years of age had numerically higher rates of in-hospital mortality compared with middle-aged and elderly patients, this difference did not reach statistical significance and younger age was not independently associated with in-hospital death. Given that male sex and acute neurological disorders emerged as independent predictors of mortality whereas age did not, similar to prior registry data (13,28,29), it is conceivable that differences in baseline characteristics may at least partially account for the worse in-hospital outcomes in patients ≤50 years of age. The InterTAK Registry is supported by The Biss Davies Charitable Trust. Dr. Karakas has received grant support outside of this work from Vifor Pharma, Adreomed AG, and Abbott Diagnostics; and has received honoraria outside of this work from Vifor Pharma, Amgen, Adrenomed AG, Sanofi, and AstraZeneca. Dr. Noutsias has been a consultant to the IKDT (Institute for Cardiac Diagnosis and Therapy GmbH, Berlin); and has received honoraria for presentations and/or participated in Advisory Boards from Abbott, Abiomed, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Fresenius, Miltenyi Biotech, Novartis, Pfizer, Roche, and Zoll. Dr. Napp has received lecture, consulting, and proctoring honoraria and travel support from Abiomed; has received lecture honoraria from Maquet; has received travel support, lecture honoraria, consulting fees, and research funding from Cytosorbents; and has received consultant fees and travel support from Bayer. Dr. Din has received honoraria from AstraZeneca. Dr. Templin has been supported by the H.H. Sheikh Khalifa bin Hamad Al-Thani Research Programme. Dr. Maier has been supported by EU HORIZON 2020 (SILICOFCM ID777204). Dr. B{\"o}hm has served as a scientific advisor for and received lecture fees from Amgen, Bayer, Servier, Medtronic, Boehringer Ingelheim, Vifor, Bristol-Myers Squibb, AstraZeneca, Novartis, and Abbott. Dr. Hasenfu{\ss} has received honorarium for lectures from AstraZeneca, Berlin Chemie, Impulse Dynamics, Novartis, Servier, and Vifor Pharma; has served as a consultant for Corvia, Impulse Dynamics, Novartis, Servier, and Virfor Pharma; has served as co-principal investigator for Impulse Dynamics; and has served on the Editorial Board of Springer. Dr. Pieske has served as a steering committee member for Novartis, Bayer Healthcare, and Merck; has served as a speaker for Bayer Healthcare, Merck, Bristol-Myers Squibb, and Servier; has received lecture fees from Medscape; and has served as a Steering Committee Member for Servier. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Funding Information: The InterTAK Registry is supported by The Biss Davies Charitable Trust. Dr. Karakas has received grant support outside of this work from Vifor Pharma, Adreomed AG, and Abbott Diagnostics; and has received honoraria outside of this work from Vifor Pharma, Amgen, Adrenomed AG, Sanofi, and AstraZeneca. Dr. Noutsias has been a consultant to the IKDT (Institute for Cardiac Diagnosis and Therapy GmbH, Berlin); and has received honoraria for presentations and/or participated in Advisory Boards from Abbott, Abiomed, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Fresenius, Miltenyi Biotech, Novartis, Pfizer, Roche, and Zoll. Dr. Napp has received lecture, consulting, and proctoring honoraria and travel support from Abiomed; has received lecture honoraria from Maquet; has received travel support, lecture honoraria, consulting fees, and research funding from Cytosorbents; and has received consultant fees and travel support from Bayer. Dr. Din has received honoraria from AstraZeneca. Dr. Templin has been supported by the H.H. Sheikh Khalifa bin Hamad Al-Thani Research Programme. Dr. Maier has been supported by EU HORIZON 2020 (SILICOFCM ID777204). Dr. B{\"o}hm has served as a scientific advisor for and received lecture fees from Amgen, Bayer, Servier, Medtronic, Boehringer Ingelheim, Vifor, Bristol-Myers Squibb, AstraZeneca, Novartis, and Abbott. Dr. Hasenfu{\ss} has received honorarium for lectures from AstraZeneca, Berlin Chemie, Impulse Dynamics, Novartis, Servier, and Vifor Pharma; has served as a consultant for Corvia, Impulse Dynamics, Novartis, Servier, and Virfor Pharma; has served as co-principal investigator for Impulse Dynamics; and has served on the Editorial Board of Springer. Dr. Pieske has served as a steering committee member for Novartis, Bayer Healthcare, and Merck; has served as a speaker for Bayer Healthcare, Merck, Bristol-Myers Squibb, and Servier; has received lecture fees from Medscape; and has served as a Steering Committee Member for Servier. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: {\textcopyright} 2020 American College of Cardiology Foundation",

year = "2020",

month = apr,

day = "28",

doi = "10.1016/j.jacc.2020.02.057",

language = "English (US)",

volume = "75",

pages = "1869--1877",

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

issn = "0735-1097",

publisher = "Elsevier USA",

number = "16",

}

TY - JOUR

T1 - Age-Related Variations in Takotsubo Syndrome

AU - Cammann, Victoria L.

AU - Szawan, Konrad A.

AU - Stähli, Barbara E.

AU - Kato, Ken

AU - Budnik, Monika

AU - Wischnewsky, Manfred

AU - Dreiding, Sara

AU - Levinson, Rena A.

AU - Di Vece, Davide

AU - Gili, Sebastiano

AU - Citro, Rodolfo

AU - Bossone, Eduardo

AU - Neuhaus, Michael

AU - Franke, Jennifer

AU - Meder, Benjamin

AU - Jaguszewski, Miłosz

AU - Noutsias, Michel

AU - Knorr, Maike

AU - Heiner, Susanne

AU - D'Ascenzo, Fabrizio

AU - Dichtl, Wolfgang

AU - Burgdorf, Christof

AU - Kherad, Behrouz

AU - Tschöpe, Carsten

AU - Sarcon, Annahita

AU - Shinbane, Jerold

AU - Rajan, Lawrence

AU - Michels, Guido

AU - Pfister, Roman

AU - Cuneo, Alessandro

AU - Jacobshagen, Claudius

AU - Karakas, Mahir

AU - Koenig, Wolfgang

AU - Pott, Alexander

AU - Meyer, Philippe

AU - Roffi, Marco

AU - Banning, Adrian

AU - Wolfrum, Mathias

AU - Cuculi, Florim

AU - Kobza, Richard

AU - Fischer, Thomas A.

AU - Vasankari, Tuija

AU - Airaksinen, K. E.Juhani

AU - Napp, L. Christian

AU - Dworakowski, Rafal

AU - MacCarthy, Philip

AU - Kaiser, Christoph

AU - Osswald, Stefan

AU - Galiuto, Leonarda

AU - Chan, Christina

AU - Bridgman, Paul

AU - Beug, Daniel

AU - Delmas, Clément

AU - Lairez, Olivier

AU - Gilyarova, Ekaterina

AU - Shilova, Alexandra

AU - Gilyarov, Mikhail

AU - El-Battrawy, Ibrahim

AU - Akin, Ibrahim

AU - Poledniková, Karolina

AU - Toušek, Petr

AU - Winchester, David E.

AU - Galuszka, Jan

AU - Ukena, Christian

AU - Poglajen, Gregor

AU - Carrilho-Ferreira, Pedro

AU - Hauck, Christian

AU - Paolini, Carla

AU - Bilato, Claudio

AU - Kobayashi, Yoshio

AU - Shoji, Toshihiro

AU - Ishibashi, Iwao

AU - Takahara, Masayuki

AU - Himi, Toshiharu

AU - Din, Jehangir

AU - Al-Shammari, Ali

AU - Prasad, Abhiram

AU - Rihal, Charanjit S.

AU - Liu, Kan

AU - Schulze, P. Christian

AU - Bianco, Matteo

AU - Jörg, Lucas

AU - Rickli, Hans

AU - Pestana, Gonçalo

AU - Nguyen, Thanh H.

AU - Böhm, Michael

AU - Maier, Lars S.

AU - Pinto, Fausto J.

AU - Widimský, Petr

AU - Felix, Stephan B.

AU - Braun-Dullaeus, Ruediger C.

AU - Rottbauer, Wolfgang

AU - Hasenfuß, Gerd

AU - Pieske, Burkert M.

AU - Schunkert, Heribert

AU - Borggrefe, Martin

AU - Thiele, Holger

AU - Bauersachs, Johann

AU - Katus, Hugo A.

AU - Horowitz, John D.

AU - Di Mario, Carlo

AU - Münzel, Thomas

AU - Crea, Filippo

AU - Bax, Jeroen J.

AU - Lüscher, Thomas F.

AU - Ruschitzka, Frank

AU - Ghadri, Jelena R.

AU - Opolski, Grzegorz

AU - Templin, Christian

N1 - Funding Information: The prevalence of cardiogenic shock and the need for intensive cardiac care treatment including catecholamine use and noninvasive and invasive ventilation was particularly high in younger TTS patients. These findings are supported by data obtained from a cohort of 114 TTS patients showing trends toward increased rates of mechanical ventilation and catecholamine use in patients ≤65 years of age (10). Although patients ≤50 years of age had numerically higher rates of in-hospital mortality compared with middle-aged and elderly patients, this difference did not reach statistical significance and younger age was not independently associated with in-hospital death. Given that male sex and acute neurological disorders emerged as independent predictors of mortality whereas age did not, similar to prior registry data (13,28,29), it is conceivable that differences in baseline characteristics may at least partially account for the worse in-hospital outcomes in patients ≤50 years of age. The InterTAK Registry is supported by The Biss Davies Charitable Trust. Dr. Karakas has received grant support outside of this work from Vifor Pharma, Adreomed AG, and Abbott Diagnostics; and has received honoraria outside of this work from Vifor Pharma, Amgen, Adrenomed AG, Sanofi, and AstraZeneca. Dr. Noutsias has been a consultant to the IKDT (Institute for Cardiac Diagnosis and Therapy GmbH, Berlin); and has received honoraria for presentations and/or participated in Advisory Boards from Abbott, Abiomed, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Fresenius, Miltenyi Biotech, Novartis, Pfizer, Roche, and Zoll. Dr. Napp has received lecture, consulting, and proctoring honoraria and travel support from Abiomed; has received lecture honoraria from Maquet; has received travel support, lecture honoraria, consulting fees, and research funding from Cytosorbents; and has received consultant fees and travel support from Bayer. Dr. Din has received honoraria from AstraZeneca. Dr. Templin has been supported by the H.H. Sheikh Khalifa bin Hamad Al-Thani Research Programme. Dr. Maier has been supported by EU HORIZON 2020 (SILICOFCM ID777204). Dr. Böhm has served as a scientific advisor for and received lecture fees from Amgen, Bayer, Servier, Medtronic, Boehringer Ingelheim, Vifor, Bristol-Myers Squibb, AstraZeneca, Novartis, and Abbott. Dr. Hasenfuß has received honorarium for lectures from AstraZeneca, Berlin Chemie, Impulse Dynamics, Novartis, Servier, and Vifor Pharma; has served as a consultant for Corvia, Impulse Dynamics, Novartis, Servier, and Virfor Pharma; has served as co-principal investigator for Impulse Dynamics; and has served on the Editorial Board of Springer. Dr. Pieske has served as a steering committee member for Novartis, Bayer Healthcare, and Merck; has served as a speaker for Bayer Healthcare, Merck, Bristol-Myers Squibb, and Servier; has received lecture fees from Medscape; and has served as a Steering Committee Member for Servier. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Funding Information: The InterTAK Registry is supported by The Biss Davies Charitable Trust. Dr. Karakas has received grant support outside of this work from Vifor Pharma, Adreomed AG, and Abbott Diagnostics; and has received honoraria outside of this work from Vifor Pharma, Amgen, Adrenomed AG, Sanofi, and AstraZeneca. Dr. Noutsias has been a consultant to the IKDT (Institute for Cardiac Diagnosis and Therapy GmbH, Berlin); and has received honoraria for presentations and/or participated in Advisory Boards from Abbott, Abiomed, AstraZeneca, Bayer, Boehringer Ingelheim, Bristol-Myers Squibb, Fresenius, Miltenyi Biotech, Novartis, Pfizer, Roche, and Zoll. Dr. Napp has received lecture, consulting, and proctoring honoraria and travel support from Abiomed; has received lecture honoraria from Maquet; has received travel support, lecture honoraria, consulting fees, and research funding from Cytosorbents; and has received consultant fees and travel support from Bayer. Dr. Din has received honoraria from AstraZeneca. Dr. Templin has been supported by the H.H. Sheikh Khalifa bin Hamad Al-Thani Research Programme. Dr. Maier has been supported by EU HORIZON 2020 (SILICOFCM ID777204). Dr. Böhm has served as a scientific advisor for and received lecture fees from Amgen, Bayer, Servier, Medtronic, Boehringer Ingelheim, Vifor, Bristol-Myers Squibb, AstraZeneca, Novartis, and Abbott. Dr. Hasenfuß has received honorarium for lectures from AstraZeneca, Berlin Chemie, Impulse Dynamics, Novartis, Servier, and Vifor Pharma; has served as a consultant for Corvia, Impulse Dynamics, Novartis, Servier, and Virfor Pharma; has served as co-principal investigator for Impulse Dynamics; and has served on the Editorial Board of Springer. Dr. Pieske has served as a steering committee member for Novartis, Bayer Healthcare, and Merck; has served as a speaker for Bayer Healthcare, Merck, Bristol-Myers Squibb, and Servier; has received lecture fees from Medscape; and has served as a Steering Committee Member for Servier. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. Publisher Copyright: © 2020 American College of Cardiology Foundation

PY - 2020/4/28

Y1 - 2020/4/28

N2 - Background: Takotsubo syndrome (TTS) occurs predominantly in post-menopausal women but is also found in younger patients. Objectives: This study aimed to investigate age-related differences in TTS. Methods: Patients diagnosed with TTS and enrolled in the International Takotsubo Registry between January 2011 and February 2017 were included in this analysis and were stratified by age (younger: ≤50 years, middle-age: 51 to 74 years, elderly: ≥75 years). Baseline characteristics, hospital course, as well as short- and long-term mortality were compared among groups. Results: Of 2,098 TTS patients, 242 (11.5%) patients were ≤50 years of age, 1,194 (56.9%) were 51 to 74 years of age, and 662 (31.6%) were ≥75 years of age. Younger patients were more often men (12.4% vs. 10.9% vs. 6.3%; p = 0.002) and had an increased prevalence of acute neurological (16.3% vs. 8.4% vs. 8.8%; p = 0.001) or psychiatric disorders (14.1% vs. 10.3% vs. 5.6%; p < 0.001) compared with middle-aged and elderly TTS patients. Furthermore, younger patients had more often cardiogenic shock (15.3% vs. 9.1% vs. 8.1%; p = 0.004) and had a numerically higher in-hospital mortality (6.6% vs. 3.6% vs. 5.1%; p = 0.07). At multivariable analysis, younger (odds ratio: 1.60; 95% confidence interval: 0.86 to 3.01; p = 0.14) and older age (odds ratio: 1.09; 95% confidence interval: 0.66 to 1.80; p = 0.75) were not independently associated with in-hospital mortality using the middle-aged group as a reference. There were no differences in 60-day mortality rates among groups. Conclusions: A substantial proportion of TTS patients are younger than 50 years of age. TTS is associated with severe complications requiring intensive care, particularly in younger patients.

AB - Background: Takotsubo syndrome (TTS) occurs predominantly in post-menopausal women but is also found in younger patients. Objectives: This study aimed to investigate age-related differences in TTS. Methods: Patients diagnosed with TTS and enrolled in the International Takotsubo Registry between January 2011 and February 2017 were included in this analysis and were stratified by age (younger: ≤50 years, middle-age: 51 to 74 years, elderly: ≥75 years). Baseline characteristics, hospital course, as well as short- and long-term mortality were compared among groups. Results: Of 2,098 TTS patients, 242 (11.5%) patients were ≤50 years of age, 1,194 (56.9%) were 51 to 74 years of age, and 662 (31.6%) were ≥75 years of age. Younger patients were more often men (12.4% vs. 10.9% vs. 6.3%; p = 0.002) and had an increased prevalence of acute neurological (16.3% vs. 8.4% vs. 8.8%; p = 0.001) or psychiatric disorders (14.1% vs. 10.3% vs. 5.6%; p < 0.001) compared with middle-aged and elderly TTS patients. Furthermore, younger patients had more often cardiogenic shock (15.3% vs. 9.1% vs. 8.1%; p = 0.004) and had a numerically higher in-hospital mortality (6.6% vs. 3.6% vs. 5.1%; p = 0.07). At multivariable analysis, younger (odds ratio: 1.60; 95% confidence interval: 0.86 to 3.01; p = 0.14) and older age (odds ratio: 1.09; 95% confidence interval: 0.66 to 1.80; p = 0.75) were not independently associated with in-hospital mortality using the middle-aged group as a reference. There were no differences in 60-day mortality rates among groups. Conclusions: A substantial proportion of TTS patients are younger than 50 years of age. TTS is associated with severe complications requiring intensive care, particularly in younger patients.

KW - Takotsubo syndrome

KW - age

KW - broken heart syndrome

KW - outcome

UR - http://www.scopus.com/inward/record.url?scp=85083723676&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=85083723676&partnerID=8YFLogxK

U2 - 10.1016/j.jacc.2020.02.057

DO - 10.1016/j.jacc.2020.02.057

M3 - Article

C2 - 32327096

AN - SCOPUS:85083723676

SN - 0735-1097

VL - 75

SP - 1869

EP - 1877

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

IS - 16

ER -

Age-Related Variations in Takotsubo Syndrome

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