ESC Heart Failure (Jun 2021)

Prognostic impact of acute pulmonary triggers in patients with takotsubo syndrome: new insights from the International Takotsubo Registry

  • Ken Kato,
  • Victoria L. Cammann,
  • L. Christian Napp,
  • Konrad A. Szawan,
  • Jozef Micek,
  • Sara Dreiding,
  • Rena A. Levinson,
  • Vanya Petkova,
  • Michael Würdinger,
  • Alexandru Patrascu,
  • Rafael Sumalinog,
  • Sebastiano Gili,
  • Christian F. Clarenbach,
  • Malcolm Kohler,
  • Manfred Wischnewsky,
  • Rodolfo Citro,
  • Carmine Vecchione,
  • Eduardo Bossone,
  • Michael Neuhaus,
  • Jennifer Franke,
  • Benjamin Meder,
  • Milosz 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,
  • Monika Budnik,
  • 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,
  • Martin Kozel,
  • Petr Tousek,
  • David E. Winchester,
  • Jan Galuszka,
  • Christian Ukena,
  • Gregor Poglajen,
  • Pedro Carrilho‐Ferreira,
  • Christian Hauck,
  • Carla Paolini,
  • Claudio Bilato,
  • Masanori Sano,
  • Iwao Ishibashi,
  • Masayuki Takahara,
  • Toshiharu Himi,
  • Yoshio Kobayashi,
  • 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,
  • Grzegorz Opolski,
  • 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,
  • Christian Templin

DOI
https://doi.org/10.1002/ehf2.13165
Journal volume & issue
Vol. 8, no. 3
pp. 1924 – 1932

Abstract

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Abstract Aims Acute pulmonary disorders are known physical triggers of takotsubo syndrome (TTS). This study aimed to investigate prevalence of acute pulmonary triggers in patients with TTS and their impact on outcomes. Methods and results Patients with TTS were enrolled from the International Takotsubo Registry and screened for triggering factors and comorbidities. Patients were categorized into three groups (acute pulmonary trigger, chronic lung disease, and no lung disease) to compare clinical characteristics and outcomes. Of the 1670 included patients with TTS, 123 (7%) were identified with an acute pulmonary trigger, and 194 (12%) had a known history of chronic lung disease. The incidence of cardiogenic shock was highest in patients with an acute pulmonary trigger compared with those with chronic lung disease or without lung disease (17% vs. 10% vs. 9%, P = 0.017). In‐hospital mortality was also higher in patients with an acute pulmonary trigger than in the other two groups, although not significantly (5.7% vs. 1.5% vs. 4.2%, P = 0.13). Survival analysis demonstrated that patients with an acute pulmonary trigger had the worst long‐term outcome (P = 0.002). The presence of an acute pulmonary trigger was independently associated with worse long‐term mortality (hazard ratio 2.12, 95% confidence interval 1.33–3.38; P = 0.002). Conclusions The present study demonstrates that TTS is related to acute pulmonary triggers in 7% of all TTS patients, which accounts for 21% of patients with physical triggers. The presence of acute pulmonary trigger is associated with a severe in‐hospital course and a worse long‐term outcome.

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