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1. A novel clinical score (InterTAK Diagnostic Score) to differentiate takotsubo syndrome from acute coronary syndrome: results from the International Takotsubo Registry

Author

Ghadri, Jr, Cammann, Vl, Jurisic, S, Seifert, B, Napp, Lc, Diekmann, J, Bataiosu, Dr, D'Ascenzo, F, Ding, Kj, Sarcon, A, Kazemian, E, Birri, T, Ruschitzka, F, Lüscher, Tf, Templin, C, InterTAK co-investigators: Jaguszewski, M, Franke, J, Katus, Ha, Burgdorf, C, Schunkert, H, Thiele, H, Bauersachs, J, Tschöpe, C, Rajan, L, Michels, G, Pfister, R, Ukena, C, Böhm, M, Erbel, R, Cuneo, A, Jacobshagen, C, Hasenfuß, G, Karakas, M, Koenig, W, Rottbauer, W, Said, Sm, Braun-Dullaeus, Rc, Cuculi, F, Banning, A, Fischer, Ta, Vasankari, T, Airaksinen, Kej, Fijalkowski, M, Rynkiewicz, A, Opolski, G, Dworakowski, R, Maccarthy, P, Kaiser, C, Osswald, S, Galiuto, L, Crea, F, Dichtl, W, Franz, Wm, Empen, K, Felix, Sb, Delmas, C, Lairez, O, Erne, P, Frantz, S, Prasad, A, and Bax, Jj

Subjects
Male, Clinical score, tako tsubo, broken heart syndrome, acute coronary syndromeacute syndrome, Medizin, Takotsubo (stress) syndrome, Diagnosis, Differential, Electrocardiography, Takotsubo Cardiomyopathy, Natriuretic Peptide, Brain, Humans, Prospective Studies, Registries, Acute Coronary Syndrome, Propensity Score, Aged, Broken heart syndrome, Acute coronary syndrome, Disease prevalence, Cardiology and Cardiovascular Medicine, Middle Aged, Peptide Fragments, Troponin, ROC Curve, Female, Biomarkers
Abstract

Aims Clinical presentation of takotsubo syndrome (TTS) mimics acute coronary syndrome (ACS) and does not allow differentiation. We aimed to develop a clinical score to estimate the probability of TTS and to distinguish TTS from ACS in the acute stage. Methods and results Patients with TTS were recruited from the International Takotsubo Registry ( www.takotsubo-registry.com) and ACS patients from the leading hospital in Zurich. A multiple logistic regression for the presence of TTS was performed in a derivation cohort (TTS, n = 218; ACS, n = 436). The best model was selected and formed a score (InterTAK Diagnostic Score) with seven variables, and each was assigned a score value: female sex 25, emotional trigger 24, physical trigger 13, absence of ST-segment depression (except in lead aVR) 12, psychiatric disorders 11, neurologic disorders 9, and QTc prolongation 6 points. The area under the curve (AUC) for the resulting score was 0.971 [95% confidence interval (CI) 0.96–0.98] and using a cut-off value of 40 score points, sensitivity was 89% and specificity 91%. When patients with a score of ≥50 were diagnosed as TTS, nearly 95% of TTS patients were correctly diagnosed. When patients with a score ≤31 were diagnosed as ACS, ∼95% of ACS patients were diagnosed correctly. The score was subsequently validated in an independent validation cohort (TTS, n = 173; ACS, n = 226), resulting in a score AUC of 0.901 (95% CI 0.87–0.93). Conclusion The InterTAK Diagnostic Score estimates the probability of the presence of TTS and is able to distinguish TTS from ACS with a high sensitivity and specificity. OA hybrid

Published
2016

2. Intraventricular thrombus formation and embolism in Takotsubo syndrome insights from the international Takotsubo registry

Author

Alexandra Shilova, Davide Di Vece, Johann Bauersachs, Wolfgang Koenig, Michael Neuhaus, Rodolfo Citro, Jose David Arroja, Adrian P. Banning, Jennifer Franke, Charanjit S. Rihal, Abhiram Prasad, Carlo Di Mario, Michael Böhm, Carsten Tschöpe, Burkhardt Seifert, Filippo Crea, Christian Templin, David E. Winchester, Hugo A. Katus, Clément Delmas, Pedro Carrilho-Ferreira, Paul Bridgman, Petr Tousek, Guido Michels, Fausto J. Pinto, Sebastiano Gili, Jelena R. Ghadri, Petr Widimský, Burkert Pieske, Jeroen J. Bax, Christian Ukena, Christoph Kaiser, Wolfgang Dichtl, Christof Burgdorf, Philippe Meyer, Christina Chan, Gerd Hasenfuß, Philip MacCarthy, Mikhail Gilyarov, Leonarda Galiuto, Grzegorz Opolski, Susanne Heiner, Ruediger C. Braun-Dullaeus, Alexander Pott, Annahita Sarcon, Ekaterina Gilyarova, Michel Noutsias, Lawrence Rajan, Claudius Jacobshagen, Roman Pfister, Behrouz Kherad, John D. Horowitz, Martin Borggrefe, Mahir Karakas, Stefan Osswald, Victoria L. Cammann, Katharina J. Ding, Jan Galuszka, Wolfgang Rottbauer, Ibrahim El-Battrawy, Stephan B. Felix, Martin Kozel, Ibrahim Akin, Thomas F. Lüscher, Frank Ruschitzka, Thomas Fischer, Fabrizio D'Ascenzo, Rafal Dworakowski, Olivier Lairez, L. Christian Napp, Holger Thiele, Eduardo Bossone, Thomas Münzel, Claudio Bilato, Maike Knorr, K.E. Juhani Airaksinen, Florim Cuculi, Carla Paolini, Konrad A. Szawan, Richard Kobza, Alessandro Cuneo, Barbara E. Stähli, Heribert Schunkert, Miłosz Jaguszewski, Manfred Wischnewsky, Tuija Vasankari, Ding, Kj, Cammann, Vl, Szawan, Ka, Stähli, Be, Wischnewsky, M, Di Vece, D, Citro, R, Jaguszewski, M, Seifert, B, Sarcon, A, Knorr, M, Heiner, S, Gili, S, D'Ascenzo, F, Neuhaus, M, Napp, Lc, Franke, J, Noutsias, M, Burgdorf, C, Koenig, W, Kherad, B, Rajan L, Michels, G, Pfister, R, Cuneo, A, Jacobshagen, C, Karakas, M, Pott, A, Meyer, P, Arroja, Jd, Banning, A, Cuculi, F, Kobza, R, Fischer, Ta, Vasankari, T, Airaksinen, Kej, Paolini, C, Bilato, C, Carrilho-Ferreira, P, Opolski, G, Dworakowski, R, Maccarthy, P, Kaiser, C, Osswald, S, Galiuto, L, Dichtl, W, Chan, C, Bridgman, P, Delmas, C, Lairez, O, El-Battrawy, I, Akin, I, Gilyarova, E, Shilova, A, Gilyarov, M, Kozel, M, Tousek, P, Widimský, P, Winchester, De, Galuszka, J, Ukena, C, Horowitz, Jd, Di Mario, C, Prasad A, Rihal, C, Pinto, Fj, Crea, F, Borggrefe, M, Braun-Dullaeus, Rc, Rottbauer, W, Bauersachs, J, Katus, Ha, Hasenfuß, G, Tschöpe, C, Pieske, Bm, Thiele, H, Schunkert, H, Böhm, M, Felix, Sb, Münzel, T, Bax, Jj, Lüscher, Tf, Ruschitzka, F, Ghadri, Jr, Bossone, E, and Templin, C.

Subjects
Male, Coronary angiography, Time Factors, Radionuclide ventriculography, 030204 cardiovascular system & hematology, Coronary Angiography, Electrocardiography, 0302 clinical medicine, Risk Factors, Registries, 030212 general & internal medicine, Framingham Risk Score, medicine.diagnostic_test, Incidence, Incidence (epidemiology), Magnetic Resonance Imaging, 3. Good health, Europe, Survival Rate, Cine, thrombus, cardiovascular system, Cardiology, outcome, Female, Cardiology and Cardiovascular Medicine, Takotsubo syndrome, medicine.medical_specialty, Heart Diseases, Heart Ventricles, Magnetic Resonance Imaging, Cine, risk score, Risk Assessment, embolism, 03 medical and health sciences, Takotsubo Cardiomyopathy, Internal medicine, medicine, Humans, cardiovascular diseases, Thrombus, Radionuclide Ventriculography, Aged, business.industry, Australia, Thrombosis, medicine.disease, United States, Embolism, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, business, Follow-Up Studies
Abstract

Objective: Takotsubo syndrome (TTS) is characterized by acute left ventricular dysfunction, which can contribute to intraventricular thrombus and embolism. Still, prevalence and clinical impact of thrombus formation and embolic events on outcome of TTS patients remain unclear. This study aimed to investigate clinical features and outcomes of patients with and without intraventricular thrombus or embolism. Additionally, factors associated with thrombus formation or embolism, as well as predictors for mortality, were identified. Approach and Results: TTS patients enrolled in the International Takotsubo Registry at 28 centers in Australia, Europe, and the United States were dichotomized according to the occurrence/absence of intraventricular thrombus or embolism. Patients with intraventricular thrombus or embolism were defined as the ThrombEmb group. Of 1676 TTS patients, 56 (3.3%) patients developed intraventricular thrombus and/or embolism following TTS diagnosis (median time interval, 2.0 days [range, 0–38 days]). Patients in the ThrombEmb group had a different clinical profile including lower left ventricular ejection fraction, higher prevalence of the apical type, elevated levels of troponin and inflammatory markers, and higher prevalence of vascular disease. In a Firth bias-reduced penalized-likelihood logistic regression model apical type, left ventricular ejection fraction ≤30%, previous vascular disease, and a white blood cell count on admission >10×10 3 cells/μL emerged as independent predictors for thrombus formation or embolism. Conclusions: Intraventricular thrombus or embolism occur in 3.3% of patients in the acute phase of TTS. A simple risk score including clinical parameters associated with intraventricular thrombus formation or embolism identifies patients at increased risk. Clinical Trial Registration: URL: http://www.clinicaltrials.gov . Unique identifier: NCT01947621.

Published
2020

3. Long-Term Prognosis of Patients With Takotsubo Syndrome

Author

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

Subjects
Male, Acute coronary syndrome, medicine.medical_specialty, Time Factors, 030204 cardiovascular system & hematology, tako tsubo syndrome, acute coronary syndrome, broken heart syndrome, classification, outcome, stress factor, Broken heart syndrome, 03 medical and health sciences, 0302 clinical medicine, Takotsubo Cardiomyopathy, Internal medicine, medicine, Humans, Registries, 030212 general & internal medicine, Mortality, Aged, Aged, 80 and over, Takotsubo syndrome, business.industry, Mortality rate, Electroencephalography, Emotional stress, Middle Aged, ta3121, Prognosis, Stress factor, medicine.disease, 3. Good health, Physical stress, Cardiology and Cardiovascular Medicine, Cohort, Female, Nervous System Diseases, business, Stress, Psychological, Follow-Up Studies
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)

Published
2018

4. Clinical Features and Outcomes of Patients With Malignancy and Takotsubo Syndrome: Observations From the International Takotsubo Registry

Author

Petr Widimský, Katharina J. Ding, Sebastiano Gili, L. Christian Napp, Holger Thiele, Stephan B. Felix, Christof Burgdorf, Thomas F. Lüscher, Johann Bauersachs, Mahir Karakas, Alexandra Shilova, Davide Di Vece, Gerd Hasenfuß, Miłosz Jaguszewski, Roman Pfister, Thomas Münzel, Hugo A. Katus, David E. Winchester, Stefan Osswald, Thomas Fischer, Guido Michels, Ruediger C. Braun-Dullaeus, Adrian P. Banning, Philip MacCarthy, Stjepan Jurisic, Burkert Pieske, Christian Ukena, Fabrizio D'Ascenzo, Christoph Kaiser, Michael Böhm, Olivier Lairez, Rodolfo Citro, Richard Kobza, Antonio H. Frangieh, John D. Horowitz, Leonarda Galiuto, Grzegorz Opolski, Susanne Heiner, Filippo Crea, Beatrice Bacchi, Annahita Sarcon, Jeroen J. Bax, Wolfgang Dichtl, Victoria L. Cammann, Jelena R. Ghadri, Ekaterina Gilyarova, Wolfgang Rottbauer, Frank Ruschitzka, Ibrahim Akin, Ibrahim El-Battrawy, Martin Borggrefe, Jozef Micek, Clément Delmas, Lawrence Rajan, Rafal Dworakowski, Mikhail Gilyarov, Christian Templin, Petr Tousek, Jerold S. Shinbane, Tuija Vasankari, Michel Noutsias, Heribert Schunkert, Wolfgang Koenig, Eduardo Bossone, Abhiram Prasad, Carlo Di Mario, Alessandro Cuneo, Ken Kato, Martin Kozel, Konrad A. Szawan, Florim Cuculi, Maike Knorr, K.E. Juhani Airaksinen, Jennifer Franke, Carsten Tschöpe, Burkhardt Seifert, Claudius Jacobshagen, Cammann, Vl, Sarcon, A, Ding, Kj, Seifert, B, Kato, K, Di Vece, D, Szawan, Ka, Gili, S, Jurisic, S, Bacchi, B, Micek, J, Frangieh, Ah, Napp, Lc, Jaguszewski, M, Bossone, E, Citro, R, D'Ascenzo, F, Franke, J, Noutsias, M, Knorr, M, Heiner, S, Burgdorf, C, Koenig, W, Thiele, H, Tschope, C, Rajan, L, Michels, G, Pfister, R, Cuneo, A, Jacobshagen, C, Karakas, M, Banning, A, Cuculi, F, Kobza, R, Fischer, Ta, Vasankari, T, Airaksinen, Kej, Dworakowski, R, Kaiser, C, Osswald, S, Galiuto, L, Dichtl, W, Delmas, C, Lairez, O, Horowitz, Jd, Kozel, M, Widimsky, P, Tousek, P, Winchester, De, Gilyarova, E, Shilova, A, Gilyarov, M, El-Battrawy, I, Akin, I, Ukena, C, Bauersachs, J, Pieske, Bm, Hasenfuss, G, Rottbauer, W, Braun-Dullaeus, Rc, Opolski, G, Maccarthy, P, Felix, Sb, Borggrefe, M, Di Mario, C, Crea, F, Katus, Ha, Schunkert, H, Munzel, T, Bohm, M, Bax, Jj, Prasad, A, Shinbane, J, Luscher, Tf, Ruschitzka, F, Ghadri, Jr, and Templin, C

Subjects
medicine.medical_specialty, Acute coronary syndrome, acute coronary syndrome, broken heart syndrome, cancer, malignancy, outcome, takotsubo syndrome, 030204 cardiovascular system & hematology, Malignancy, Broken heart syndrome, 03 medical and health sciences, 0302 clinical medicine, Takotsubo Cardiomyopathy, Neoplasms, Internal medicine, medicine, Humans, In patient, Registries, 030212 general & internal medicine, Original Research, Heart Failure, Takotsubo syndrome, business.industry, Cancer, medicine.disease, ddc, 3. Good health, Clinical trial, Cohort, Cardiology and Cardiovascular Medicine, business
Abstract

Background Clinical characteristics and outcomes of takotsubo syndrome (TTS) patients with malignancy have not been fully elucidated. This study sought to explore differences in clinical characteristics and to investigate short‐ and long‐term outcomes in TTS patients with or without malignancy. Methods and Results TTS patients were enrolled from the International Takotsubo Registry. The TTS cohort was divided into patients with and without malignancy to investigate differences in clinical characteristics and to assess short‐ and long‐term mortality. A subanalysis was performed comparing long‐term mortality between a subset of TTS patients with or without malignancy and acute coronary syndrome (ACS) patients with or without malignancy. Malignancy was observed in 16.6% of 1604 TTS patients. Patients with malignancy were older and more likely to have physical triggers, but less likely to have emotional triggers compared with those without malignancy. Long‐term mortality was higher in patients with malignancy (P, See Editorial Angelini and Uribe

Published
2019

5. Cardiac arrest in takotsubo syndrome: results from the InterTAK Registry

Author

David E. Winchester, Philip MacCarthy, Leonarda Galiuto, Guido Michels, Hugo A. Katus, Grzegorz Opolski, Susanne Heiner, Burkert Pieske, Christian Ukena, Wolfgang Koenig, Richard Kobza, Sebastiano Gili, Christoph Kaiser, Eduardo Bossone, Beatrice Bacchi, Johann Bauersachs, Filippo Crea, K.E. Juhani Airaksinen, Konrad A. Szawan, Heribert Schunkert, Abhiram Prasad, Carlo Di Mario, John D. Horowitz, L. Christian Napp, Holger Thiele, Gerd Hasenfuß, Rafal Dworakowski, Ekaterina Gilyarova, Roman Pfister, Christof Burgdorf, Christian Templin, Flurina Famos, Stjepan Jurisic, Victoria L. Cammann, Stefan Osswald, Miłosz Jaguszewski, Maike Knorr, Wolfgang Rottbauer, Alexandra Shilova, Ibrahim Akin, Petr Tousek, Jeroen J. Bax, Adrian P. Banning, Lawrence Rajan, Alessandro Cuneo, Davide Di Vece, Claudius Jacobshagen, Katharina J. Ding, Susanne A. Schlossbauer, Jennifer Franke, Ruediger C. Braun-Dullaeus, Manfred Wischnewsky, Klaus Empen, Michael Böhm, Carsten Tschöpe, Petr Widimský, Stephan B. Felix, Olivier Lairez, Burkhardt Seifert, Thomas Münzel, Michel Noutsias, Tuija Vasankari, Thomas F. Lüscher, Ibrahim El-Battrawy, Slayman Obeid, Fabrizio D'Ascenzo, Florim Cuculi, Mikhail Gilyarov, Rodolfo Citro, Mahir Karakas, Ken Kato, Jozef Micek, Fiorenzo Gaita, Martin Kozel, Wolfgang Dichtl, Clément Delmas, Rena A. Levinson, Samir M. Said, Olivia Lenoir, Annahita Sarcon, Thomas Fischer, Jelena R. Ghadri, Martin Borggrefe, Frank Ruschitzka, Gili, S, Cammann, Vl, Schlossbauer, Sa, Kato, K, D'Ascenzo, F, Di Vece, D, Jurisic, S, Micek, J, Obeid, S, Bacchi, B, Szawan, Ka, Famos, F, Sarcon, A, Levinson, R, Ding, Kj, Seifert, B, Lenoir, O, Bossone, E, Citro, R, Franke, J, Napp, Lc, Jaguszewski, M, Noutsias, M, Munzel, T, Knorr, M, Heiner, S, Katus, Ha, Burgdorf, C, Schunkert, H, Thiele, H, Bauersachs, J, Tschope, 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, Gilyarova, E, Shilova, A, Gilyarov, M, Horowitz, Jd, Kozel, M, Tousek, P, Widimsky, P, Winchester, De, Ukena, C, Gaita, F, Di Mario, C, Wischnewsky, Mb, Bax, Jj, Prasad, A, Bohm, M, Ruschitzka, F, Luscher, Tf, Ghadri, Jr, and Templin, C

Subjects
Male, Tachycardia, Acute heart failure, Broken heart syndrome, Cardiac arrest, Outcome, Takotsubo syndrome, medicine.medical_specialty, Cardiomyopathy, 030204 cardiovascular system & hematology, 03 medical and health sciences, 0302 clinical medicine, Clinical Research, Takotsubo Cardiomyopathy, Internal medicine, Humans, Medicine, Registries, 030212 general & internal medicine, Asystole, Retrospective Studies, Ejection fraction, business.industry, Atrial fibrillation, Middle Aged, Prognosis, medicine.disease, Survival Analysis, ddc, Heart Arrest, 3. Good health, Editor's Choice, Editorial, Pulseless electrical activity, Ventricular fibrillation, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Cardiology, Female, medicine.symptom, Cardiology and Cardiovascular Medicine, business
Abstract

Aims We aimed to evaluate the frequency, clinical features, and prognostic implications of cardiac arrest (CA) in takotsubo syndrome (TTS). Methods and results We reviewed the records of patients with CA and known heart rhythm from the International Takotsubo Registry. The main outcomes were 60-day and 5-year mortality. In addition, predictors of mortality and predictors of CA during the acute TTS phase were assessed. Of 2098 patients, 103 patients with CA and known heart rhythm during CA were included. Compared with patients without CA, CA patients were more likely to be younger, male, and have apical TTS, atrial fibrillation (AF), neurologic comorbidities, physical triggers, and longer corrected QT-interval and lower left ventricular ejection fraction on admission. In all, 57.1% of patients with CA at admission had ventricular fibrillation/tachycardia, while 73.7% of patients with CA in the acute phase had asystole/pulseless electrical activity. Patients with CA showed higher 60-day (40.3% vs. 4.0%, P Conclusions Cardiac arrest is relatively frequent in TTS and is associated with higher short- and long-term mortality. Clinical and electrocardiographic parameters independently predicted mortality after CA.

Published
2019

6. Outcomes Associated With Cardiogenic Shock in Takotsubo Syndrome: Results From the International Takotsubo Registry

Author

Roman Pfister, Florim Cuculi, Stefan Osswald, Michel Noutsias, Klaus Empen, Annahita Sarcon, Philip MacCarthy, Alessandro Cuneo, Tuija Vasankari, Ruediger C. Braun-Dullaeus, Alessandro Candreva, Rodolfo Citro, Mahir Karakas, Katharina J. Ding, Christian Templin, Wolfgang Koenig, Petr Tousek, L. Christian Napp, Fabrizio D'Ascenzo, Petr Widimský, Samir M. Said, Richard Kobza, Olivier Lairez, Holger Thiele, K.E. Juhani Airaksinen, Beatrice Bacchi, Abhiram Prasad, Carlo Di Mario, David E. Winchester, Eduardo Bossone, Filippo Crea, Claudius Jacobshagen, Heribert Schunkert, Guido Michels, Alexandra Shilova, Sebastiano Gili, Jozef Micek, Ekaterina Gilyarova, Konrad A. Szawan, Davide Di Vece, Burkert Pieske, Carsten Tschöpe, Thomas Fischer, Thomas Münzel, Christian Ukena, Christoph Kaiser, Adrian P. Banning, Stephan B. Felix, Jennifer Franke, John D. Horowitz, Thomas F. Lüscher, Hugo A. Katus, Jelena-R. Ghadri, Christof Burgdorf, Ken Kato, Martin Borggrefe, Michael Böhm, Miłosz Jaguszewski, Martin Kozel, Frank Ruschitzka, Maike Knorr, Victoria L. Cammann, Ibrahim El-Battrawy, Wolfgang Rottbauer, Moritz Schwyzer, Stjepan Jurisic, Ibrahim Akin, Clément Delmas, Mikhail Gilyarov, Jeroen J. Bax, Leonarda Galiuto, Grzegorz Opolski, Susanne Heiner, Johann Bauersachs, Gerd Hasenfuβ, Rafal Dworakowski, Lawrence Rajan, Wolfgang Dichtl, Di Vece, D, Citro, R, Cammann, Vl, Kato, K, Gili, S, Szawan, Ka, Micek, J, Jurisic, S, Ding, Kj, Bacchi, B, Schwyzer, M, Candreva, A, Bossone, E, D'Ascenzo, F, Sarcon, A, Franke, J, Napp, Lc, Jaguszewski, M, Noutsias, M, Munzel, T, Knorr, M, Heiner, S, Katus, Ha, Burgdorf, C, Schunkert, H, Thiele, H, Bauersachs, J, Tschope, 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, Kj, 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, Gilyarova, E, Shilova, A, Gilyarov, M, Horowitz, J, Kozel, M, Tousek, P, Widimsky, P, Winchester, De, Ukena, C, Di Mario, C, Prasad, A, Bohm, M, Bax, Jj, Luscher, Tf, Ruschitzka, F, Ghadri, Jr, and Templin, C

Subjects
Male, medicine.medical_specialty, Time Factors, Comorbidity, 030204 cardiovascular system & hematology, Risk Assessment, Broken heart syndrome, 03 medical and health sciences, 0302 clinical medicine, Informed consent, Risk Factors, Takotsubo Cardiomyopathy, Physiology (medical), cardiac mechanical support, Medicine, Humans, takotsubo syndrome, 030212 general & internal medicine, Hospital Mortality, Prospective Studies, Registries, broken heart syndrome, cardiogenic shock, outcome, Aged, Female, Middle Aged, Prognosis, Retrospective Studies, Shock, Cardiogenic, Takotsubo syndrome, business.industry, Cardiogenic shock, Incidence (epidemiology), Medical record, Ethics committee, Shock, ta3121, medicine.disease, Cardiogenic, 3. Good health, Emergency medicine, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Observational study, Cardiology and Cardiovascular Medicine, business
Abstract

The clinical course of takotsubo syndrome (TTS) can be complicated by several life-threatening conditions. In particular, cardiogenic shock (CS) represents one of the leading causes of mortality in the acute phase and occurs in a considerable number of patients with TTS, with an incidence of ≈10%. At present, no established guidelines are available to support specific treatment recommendations,and the conventional therapy for CS leads to uncertain results in TTS cases. The International Takotsubo Registry (www.takotsubo-registry.com) is an observational, prospective, and retrospective registry established at the University Hospital Zurich in 2011, with the largest TTS database worldwide. Patients were included in the registry between 2011 and 2017 based on modified Mayo Clinic Diagnostic criteria. Hospitalization data were recorded through standardized forms on admission or during revision of clinical charts; follow-up data were obtained from medical records, telephone follow-up, or clinical visits. The study population was categorized into 2 groups: patients with TTS with and without CS. The study protocol was reviewed by the respective local ethics committees or investigational review boards at each collaboration site. Where informed consent was required, formal written consent was obtained from patients.

Published
2019

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