Natural history and predictors of mortality of patients with Takotsubo syndrome

Hyunsu Kim, Conor Senecal, Bradley Lewis, Abhiram Prasad, Rajiv Gulati, Lilach O Lerman, Amir Lerman

Research output: Contribution to journalArticle

11 Citations (Scopus)

Abstract

Background: Takotsubo syndrome is a unique transient cardiomyopathy. The pathogenesis, management, and long-term prognosis of Takotsubo syndrome are incompletely understood. The study was designed to evaluate the natural history and determinants of outcomes in patients with Takotsubo syndrome patients. Methods: We analyzed 265 patients in the Mayo Clinic Takotsubo syndrome registry for clinical presentation, treatment, and long-term outcomes with a focus on identifying prognostic factors for mortality and recurrence. Results: 95% of patients were women with a mean age of 70 ± 11.8 years. Among 257 patients discharged alive, there were 89 (34.6%) deaths, 18 (6.8%) non-fatal myocardial infarction, 12 (4.7%) cerebrovascular accidents and 23 (8.9%) re-hospitalization for heart failure over a mean follow-up of 5.8 ± 3.6 years. Only 4 (5%) patients died from cardiac causes. Cancer was the single leading cause of death. Overall 1-year survival rate was 94.2%. Independent prognostic predictors of mortality were a history of cancer (HR 2.004, 1.334–3.012, p = 0.004), physical stress as precipitating factors (HR 1.882, 1.256–2.822, p = 0.012), history of depression (HR 1.622, 1.085–2.425, p = 0.009) and increased age (HR 1.059, 1.037–1.081, p < 0.001) after multivariate analysis. Beta-blockers and ACE inhibitors at discharge were not significant predictors. There were 24 (9.1%) recurrences during follow-up, but there were no significant differences in medical therapy compared to patients without recurrence. Conclusion: The high mortality rate is related to non-cardiac co-morbidities such as cancer. Additional determinants include physical stressors, increased age, and history of depression. Use of beta-blockers and ACE inhibitors did not affect development, prognosis or recurrence.

Original languageEnglish (US)
JournalInternational Journal of Cardiology
DOIs
StateAccepted/In press - Jan 1 2018

Fingerprint

Takotsubo Cardiomyopathy
Natural History
Mortality
Recurrence
Angiotensin-Converting Enzyme Inhibitors
Precipitating Factors
Neoplasms
Cardiomyopathies
Registries
Cause of Death
Hospitalization
Multivariate Analysis
Survival Rate
Heart Failure
Stroke
Myocardial Infarction
Morbidity
Therapeutics

Keywords

  • Mortality
  • Prognosis
  • Recurrence
  • Takotsubo syndrome

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Natural history and predictors of mortality of patients with Takotsubo syndrome. / Kim, Hyunsu; Senecal, Conor; Lewis, Bradley; Prasad, Abhiram; Gulati, Rajiv; Lerman, Lilach O; Lerman, Amir.

In: International Journal of Cardiology, 01.01.2018.

Research output: Contribution to journalArticle

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abstract = "Background: Takotsubo syndrome is a unique transient cardiomyopathy. The pathogenesis, management, and long-term prognosis of Takotsubo syndrome are incompletely understood. The study was designed to evaluate the natural history and determinants of outcomes in patients with Takotsubo syndrome patients. Methods: We analyzed 265 patients in the Mayo Clinic Takotsubo syndrome registry for clinical presentation, treatment, and long-term outcomes with a focus on identifying prognostic factors for mortality and recurrence. Results: 95{\%} of patients were women with a mean age of 70 ± 11.8 years. Among 257 patients discharged alive, there were 89 (34.6{\%}) deaths, 18 (6.8{\%}) non-fatal myocardial infarction, 12 (4.7{\%}) cerebrovascular accidents and 23 (8.9{\%}) re-hospitalization for heart failure over a mean follow-up of 5.8 ± 3.6 years. Only 4 (5{\%}) patients died from cardiac causes. Cancer was the single leading cause of death. Overall 1-year survival rate was 94.2{\%}. Independent prognostic predictors of mortality were a history of cancer (HR 2.004, 1.334–3.012, p = 0.004), physical stress as precipitating factors (HR 1.882, 1.256–2.822, p = 0.012), history of depression (HR 1.622, 1.085–2.425, p = 0.009) and increased age (HR 1.059, 1.037–1.081, p < 0.001) after multivariate analysis. Beta-blockers and ACE inhibitors at discharge were not significant predictors. There were 24 (9.1{\%}) recurrences during follow-up, but there were no significant differences in medical therapy compared to patients without recurrence. Conclusion: The high mortality rate is related to non-cardiac co-morbidities such as cancer. Additional determinants include physical stressors, increased age, and history of depression. Use of beta-blockers and ACE inhibitors did not affect development, prognosis or recurrence.",
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AU - Senecal, Conor

AU - Lewis, Bradley

AU - Prasad, Abhiram

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AU - Lerman, Lilach O

AU - Lerman, Amir

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N2 - Background: Takotsubo syndrome is a unique transient cardiomyopathy. The pathogenesis, management, and long-term prognosis of Takotsubo syndrome are incompletely understood. The study was designed to evaluate the natural history and determinants of outcomes in patients with Takotsubo syndrome patients. Methods: We analyzed 265 patients in the Mayo Clinic Takotsubo syndrome registry for clinical presentation, treatment, and long-term outcomes with a focus on identifying prognostic factors for mortality and recurrence. Results: 95% of patients were women with a mean age of 70 ± 11.8 years. Among 257 patients discharged alive, there were 89 (34.6%) deaths, 18 (6.8%) non-fatal myocardial infarction, 12 (4.7%) cerebrovascular accidents and 23 (8.9%) re-hospitalization for heart failure over a mean follow-up of 5.8 ± 3.6 years. Only 4 (5%) patients died from cardiac causes. Cancer was the single leading cause of death. Overall 1-year survival rate was 94.2%. Independent prognostic predictors of mortality were a history of cancer (HR 2.004, 1.334–3.012, p = 0.004), physical stress as precipitating factors (HR 1.882, 1.256–2.822, p = 0.012), history of depression (HR 1.622, 1.085–2.425, p = 0.009) and increased age (HR 1.059, 1.037–1.081, p < 0.001) after multivariate analysis. Beta-blockers and ACE inhibitors at discharge were not significant predictors. There were 24 (9.1%) recurrences during follow-up, but there were no significant differences in medical therapy compared to patients without recurrence. Conclusion: The high mortality rate is related to non-cardiac co-morbidities such as cancer. Additional determinants include physical stressors, increased age, and history of depression. Use of beta-blockers and ACE inhibitors did not affect development, prognosis or recurrence.

AB - Background: Takotsubo syndrome is a unique transient cardiomyopathy. The pathogenesis, management, and long-term prognosis of Takotsubo syndrome are incompletely understood. The study was designed to evaluate the natural history and determinants of outcomes in patients with Takotsubo syndrome patients. Methods: We analyzed 265 patients in the Mayo Clinic Takotsubo syndrome registry for clinical presentation, treatment, and long-term outcomes with a focus on identifying prognostic factors for mortality and recurrence. Results: 95% of patients were women with a mean age of 70 ± 11.8 years. Among 257 patients discharged alive, there were 89 (34.6%) deaths, 18 (6.8%) non-fatal myocardial infarction, 12 (4.7%) cerebrovascular accidents and 23 (8.9%) re-hospitalization for heart failure over a mean follow-up of 5.8 ± 3.6 years. Only 4 (5%) patients died from cardiac causes. Cancer was the single leading cause of death. Overall 1-year survival rate was 94.2%. Independent prognostic predictors of mortality were a history of cancer (HR 2.004, 1.334–3.012, p = 0.004), physical stress as precipitating factors (HR 1.882, 1.256–2.822, p = 0.012), history of depression (HR 1.622, 1.085–2.425, p = 0.009) and increased age (HR 1.059, 1.037–1.081, p < 0.001) after multivariate analysis. Beta-blockers and ACE inhibitors at discharge were not significant predictors. There were 24 (9.1%) recurrences during follow-up, but there were no significant differences in medical therapy compared to patients without recurrence. Conclusion: The high mortality rate is related to non-cardiac co-morbidities such as cancer. Additional determinants include physical stressors, increased age, and history of depression. Use of beta-blockers and ACE inhibitors did not affect development, prognosis or recurrence.

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