Evaluation of Recurrent Takotsubo Syndrome

Paul Marano, MD; Jenna Maughan, BA; Okezi Obrutu, MBBS, MPH; Marie Lauzon, MS; Benita Tjoe, MD; Romana Herscovici, MD; Prizzi Moy, BA; Natalie Rojas, AA; Chrisandra Shufelt, MD, MS; Thomas Rutledge, PhD; Janet Wei, MD; C. Noel Bairey Merz, MD

JACC: Advances (Oct 2024)

Evaluation of Recurrent Takotsubo Syndrome

Paul Marano, MD,
Jenna Maughan, BA,
Okezi Obrutu, MBBS, MPH,
Marie Lauzon, MS,
Benita Tjoe, MD,
Romana Herscovici, MD,
Prizzi Moy, BA,
Natalie Rojas, AA,
Chrisandra Shufelt, MD, MS,
Thomas Rutledge, PhD,
Janet Wei, MD,
C. Noel Bairey Merz, MD

Affiliations

Paul Marano, MD: Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Jenna Maughan, BA: Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Okezi Obrutu, MBBS, MPH: Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Marie Lauzon, MS: Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Benita Tjoe, MD: Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Romana Herscovici, MD: Department of Cardiac Surgery and Cardiology, Tel Aviv University, Tel Aviv, Israel; Leviev Cardiothoracic and Vascular Center, Sheba Medical Center, affiliated to the Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
Prizzi Moy, BA: Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Natalie Rojas, AA: Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
Chrisandra Shufelt, MD, MS: Mayo Clinic Women’s Health and Division of General Internal Medicine, Jacksonville, Florida, USA
Thomas Rutledge, PhD: Psychology Service, VA San Diego Healthcare System, San Diego, California, USA; Department of Psychiatry, UC San Diego, San Diego, California, USA
Janet Wei, MD: Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA
C. Noel Bairey Merz, MD: Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Barbra Streisand Women’s Heart Center, Cedars-Sinai Smidt Heart Institute, Cedars-Sinai Medical Center, Los Angeles, California, USA; Address for correspondence: Dr C. Noel Bairey Merz, Barbra Streisand Women’s Heart Center, Cedars-Sinai Medical Center, 127 S. San Vicente Blvd., Los Angeles, California 90048, USA.

Journal volume & issue: Vol. 3, no. 10
p. 101247

Abstract

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Background: After an initial Takotsubo syndrome (TTS) event, there is growing recognition of adverse long-term outcomes, including recurrent TTS events. Recurrent events have been incompletely evaluated. Objectives: The objective of this study was to characterize recurrent TTS events and evaluate variables associated with recurrence. Methods: We studied 88 consecutive participants in the Cedars-Sinai Smidt Heart Institute Takotsubo Registry, an observational registry collecting retrospective and prospective data in TTS survivors. Detailed medical records are adjudicated. Standardized psychosocial questionnaires are administered remotely. Results: Of 88 participants with adjudicated TTS, 15 (17%) experienced at least 1 recurrent TTS event (median 3.30 years to first recurrent event, range 0.13-18.56 years). In 9 of these 15 participants, there were different patterns of wall motion abnormalities observed between events. The recurrence-free survival significantly differed based on the pattern of wall motion abnormalities at the index TTS event. Clinical, electrocardiographic, echocardiographic, and invasive data obtained at the index TTS event were similar between participants who went on to have at least 1 recurrent event and those who did not. Conclusions: Recurrent TTS episodes occurred in a significant proportion of cases, a median of 3.30 years after the index event. The recurrent episodes often had distinct triggers and different wall motion abnormalities compared to the index event. The wall motion pattern at the index event impacted the recurrence-free survival, though confirmatory studies are needed. TTS participants had a high rate of adverse psychosocial stress characteristics based on detailed questionnaires. (The Cedars-Sinai Smidt Heart Institute Takotsubo Registry & Proteomic Study; NCT03910569)

Published in JACC: Advances

ISSN: 2772-963X (Online)
Publisher: Elsevier
Country of publisher: United States
LCC subjects: Medicine: Internal medicine: Specialties of internal medicine: Diseases of the circulatory (Cardiovascular) system; Medicine: Internal medicine: Medical emergencies. Critical care. Intensive care. First aid
Website: https://www.sciencedirect.com/journal/jacc-advances

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