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1. Machine learning-based prediction of in-hospital death for patients with takotsubo syndrome: The InterTAK-ML model

Author: De Filippo, Ovidio, Cammann, Victoria L; https://orcid.org/0000-0001-7240-6593, Pancotti, Corrado, Di Vece, Davide, Silverio, Angelo, Schweiger, Victor, Niederseer, David; https://orcid.org/0000-0003-3089-1222, Szawan, Konrad A, Würdinger, Michael, Koleva, Iva, Dusi, Veronica, Bellino, Michele, Vecchione, Carmine, Parodi, Guido, Bossone, Eduardo, Gili, Sebastiano; https://orcid.org/0000-0002-0542-0448, Neuhaus, Michael, Franke, Jennifer, Meder, Benjamin, Jaguszewski, Miłosz, Noutsias, Michel, Knorr, Maike, Jansen, Thomas, Dichtl, Wolfgang, von Lewinski, Dirk; https://orcid.org/0000-0001-9996-6128, Burgdorf, Christof, Kherad, Behrouz, Tschöpe, Carsten, Sarcon, Annahita, Lüscher, Thomas F; https://orcid.org/0000-0002-5259-538X, et al, De Filippo, Ovidio, Cammann, Victoria L; https://orcid.org/0000-0001-7240-6593, Pancotti, Corrado, Di Vece, Davide, Silverio, Angelo, Schweiger, Victor, Niederseer, David; https://orcid.org/0000-0003-3089-1222, Szawan, Konrad A, Würdinger, Michael, Koleva, Iva, Dusi, Veronica, Bellino, Michele, Vecchione, Carmine, Parodi, Guido, Bossone, Eduardo, Gili, Sebastiano; https://orcid.org/0000-0002-0542-0448, Neuhaus, Michael, Franke, Jennifer, Meder, Benjamin, Jaguszewski, Miłosz, Noutsias, Michel, Knorr, Maike, Jansen, Thomas, Dichtl, Wolfgang, von Lewinski, Dirk; https://orcid.org/0000-0001-9996-6128, Burgdorf, Christof, Kherad, Behrouz, Tschöpe, Carsten, Sarcon, Annahita, Lüscher, Thomas F; https://orcid.org/0000-0002-5259-538X, and et al
Abstract: AIMS Takotsubo syndrome (TTS) is associated with a substantial rate of adverse events. We sought to design a machine learning (ML)-based model to predict the risk of in-hospital death and to perform a clustering of TTS patients to identify different risk profiles. METHODS AND RESULTS A ridge logistic regression-based ML model for predicting in-hospital death was developed on 3482 TTS patients from the International Takotsubo (InterTAK) Registry, randomly split in a train and an internal validation cohort (75% and 25% of the sample size, respectively) and evaluated in an external validation cohort (1037 patients). Thirty-one clinically relevant variables were included in the prediction model. Model performance represented the primary endpoint and was assessed according to area under the curve (AUC), sensitivity and specificity. As secondary endpoint, a K-medoids clustering algorithm was designed to stratify patients into phenotypic groups based on the 10 most relevant features emerging from the main model. The overall incidence of in-hospital death was 5.2%. The InterTAK-ML model showed an AUC of 0.89 (0.85-0.92), a sensitivity of 0.85 (0.78-0.95) and a specificity of 0.76 (0.74-0.79) in the internal validation cohort and an AUC of 0.82 (0.73-0.91), a sensitivity of 0.74 (0.61-0.87) and a specificity of 0.79 (0.77-0.81) in the external cohort for in-hospital death prediction. By exploiting the 10 variables showing the highest feature importance, TTS patients were clustered into six groups associated with different risks of in-hospital death (28.8% vs. 15.5% vs. 5.4% vs. 1.0.8% vs. 0.5%) which were consistent also in the external cohort. CONCLUSION A ML-based approach for the identification of TTS patients at risk of adverse short-term prognosis is feasible and effective. The InterTAK-ML model showed unprecedented discriminative capability for the prediction of in-hospital death.
Published: 2023

2. Ethnic comparison in takotsubo syndrome: novel insights from the International Takotsubo Registry

Author: Imori, Yoichi, Kato, Ken, Cammann, Victoria L., Szawan, Konrad A., Wischnewsky, Manfred, Dreiding, Sara, Wuerdinger, Michael, Schoenberger, Maximilian, Petkova, Vanya, Niederseer, David, Levinson, Rena A., Di Vece, Davide, Gili, Sebastiano, Seifert, Burkhardt, Wakita, Masaki, Suzuki, Noriko, Citro, Rodolfo, Bossone, Eduardo, Heiner, Susanne, Knorr, Maike, Jansen, Thomas, Muenzel, Thomas, D'Ascenzo, Fabrizio, Franke, Jennifer, Sorici-Barb, Ioana, Katus, Hugo A., Sarcon, Annahita, Shinbane, Jerold, Napp, L. Christian, Bauersachs, Johann, Jaguszewski, Milosz, Shiomura, Reiko, Nakamura, Shunichi, Takano, Hitoshi, Noutsias, Michel, Burgdorf, Christof, Ishibashi, Iwao, Himi, Toshiharu, Koenig, Wolfgang, Schunkert, Heribert, Thiele, Holger, Kherad, Behrouz, Tschope, Carsten, Pieske, Burkert M., Rajan, Lawrence, Michels, Guido, Pfister, Roman, Mizuno, Shingo, Cuneo, Alessandro, Jacobshagen, Claudius, Hasenfuss, Gerd, Karakas, Mahir, Mochizuki, Hiroki, Pott, Alexander, Rottbauer, Wolfgang, Said, Samir M., Braun-Dullaeus, Ruediger C., Banning, Adrian, Isogai, Toshiaki, Kimura, Akihisa, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Tomita, Yasuhiro, Budnik, Monika, Opolski, Grzegorz, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Crea, Filippo, Dichtl, Wolfgang, Murakami, Tsutomu, Ikari, Yuji, Empen, Klaus, Beug, Daniel, Felix, Stephan B., Delmas, Clement, Lairez, Olivier, Yamaguchi, Tetsuo, El-Battrawy, Ibrahim, Akin, Ibrahim, Borggrefe, Martin, Horowitz, John D., Kozel, Martin, Tousek, Petr, Widimsky, Petr, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Neuhaus, Michael, Meyer, Philippe, Arroja, Jose David, Chan, Christina, Bridgman, Paul, Galuszka, Jan, Poglajen, Gregor, Carrilho-Ferreira, Pedro, Pinto, Fausto J., Hauck, Christian, Maier, Lars S., Liu, Kan, Di Mario, Carlo, Paolini, Carla, Bilato, Claudio, Bianco, Matteo, Joerg, Lucas, Rickli, Hans, Winchester, David E., Ukena, Christian, Boehm, Michael, Bax, Jeroen J., Prasad, Abhiram, Rihal, Charanjit S., Saito, Shigeru, Kobayashi, Yoshio, Luscher, Thomas F., Ruschitzka, Frank, Shimizu, Wataru, Ghadri, Jelena R., Templin, Christian, Imori, Yoichi, Kato, Ken, Cammann, Victoria L., Szawan, Konrad A., Wischnewsky, Manfred, Dreiding, Sara, Wuerdinger, Michael, Schoenberger, Maximilian, Petkova, Vanya, Niederseer, David, Levinson, Rena A., Di Vece, Davide, Gili, Sebastiano, Seifert, Burkhardt, Wakita, Masaki, Suzuki, Noriko, Citro, Rodolfo, Bossone, Eduardo, Heiner, Susanne, Knorr, Maike, Jansen, Thomas, Muenzel, Thomas, D'Ascenzo, Fabrizio, Franke, Jennifer, Sorici-Barb, Ioana, Katus, Hugo A., Sarcon, Annahita, Shinbane, Jerold, Napp, L. Christian, Bauersachs, Johann, Jaguszewski, Milosz, Shiomura, Reiko, Nakamura, Shunichi, Takano, Hitoshi, Noutsias, Michel, Burgdorf, Christof, Ishibashi, Iwao, Himi, Toshiharu, Koenig, Wolfgang, Schunkert, Heribert, Thiele, Holger, Kherad, Behrouz, Tschope, Carsten, Pieske, Burkert M., Rajan, Lawrence, Michels, Guido, Pfister, Roman, Mizuno, Shingo, Cuneo, Alessandro, Jacobshagen, Claudius, Hasenfuss, Gerd, Karakas, Mahir, Mochizuki, Hiroki, Pott, Alexander, Rottbauer, Wolfgang, Said, Samir M., Braun-Dullaeus, Ruediger C., Banning, Adrian, Isogai, Toshiaki, Kimura, Akihisa, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Tomita, Yasuhiro, Budnik, Monika, Opolski, Grzegorz, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Crea, Filippo, Dichtl, Wolfgang, Murakami, Tsutomu, Ikari, Yuji, Empen, Klaus, Beug, Daniel, Felix, Stephan B., Delmas, Clement, Lairez, Olivier, Yamaguchi, Tetsuo, El-Battrawy, Ibrahim, Akin, Ibrahim, Borggrefe, Martin, Horowitz, John D., Kozel, Martin, Tousek, Petr, Widimsky, Petr, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Neuhaus, Michael, Meyer, Philippe, Arroja, Jose David, Chan, Christina, Bridgman, Paul, Galuszka, Jan, Poglajen, Gregor, Carrilho-Ferreira, Pedro, Pinto, Fausto J., Hauck, Christian, Maier, Lars S., Liu, Kan, Di Mario, Carlo, Paolini, Carla, Bilato, Claudio, Bianco, Matteo, Joerg, Lucas, Rickli, Hans, Winchester, David E., Ukena, Christian, Boehm, Michael, Bax, Jeroen J., Prasad, Abhiram, Rihal, Charanjit S., Saito, Shigeru, Kobayashi, Yoshio, Luscher, Thomas F., Ruschitzka, Frank, Shimizu, Wataru, Ghadri, Jelena R., and Templin, Christian
Abstract: Background Ethnic disparities have been reported in cardiovascular disease. However, ethnic disparities in takotsubo syndrome (TTS) remain elusive. This study assessed differences in clinical characteristics between Japanese and European TTS patients and determined the impact of ethnicity on in-hospital outcomes. Methods TTS patients in Japan were enrolled from 10 hospitals and TTS patients in Europe were enrolled from 32 hospitals participating in the International Takotsubo Registry. Clinical characteristics and in-hospital outcomes were compared between Japanese and European patients. Results A total of 503 Japanese and 1670 European patients were included. Japanese patients were older (72.6 +/- 11.4 years vs. 68.0 +/- 12.0 years; p < 0.001) and more likely to be male (18.5 vs. 8.4%; p< 0.001) than European TTS patients. Physical triggering factors were more common (45.5 vs. 32.0%; p < 0.001), and emotional triggers less common (17.5 vs. 31.5%; p < 0.001), in Japanese patients than in European patients. Japanese patients were more likely to experience cardiogenic shock during the acute phase (15.5 vs. 9.0%; p < 0.001) and had a higher in-hospital mortality (8.2 vs. 3.2%; p< 0.001). However, ethnicity itself did not appear to have an impact on in-hospital mortality. Machine learning approach revealed that the presence of physical stressors was the most important prognostic factor in both Japanese and European TTS patients. Conclusion Differences in clinical characteristics and in-hospital outcomes between Japanese and European TTS patients exist. Ethnicity does not impact the outcome in TTS patients. The worse in-hospital outcome in Japanese patients, is mainly driven by the higher prevalence of physical triggers.
Published: 2022

3. Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry

Author: El-Battrawy, Ibrahim, Cammann, Victoria L., Kato, Ken, Szawan, Konrad A., Di Vece, Davide, Rossi, Aurelio, Wischnewsky, Manfred, Hermes-Laufer, Julia, Gili, Sebastiano, Citro, Rodolfo, Bossone, Eduardo, Neuhaus, Michael, Franke, Jennifer, Meder, Benjamin, Jaguszewski, Milosz, Noutsias, Michel, Knorr, Maike, Heiner, Susanne, D'Ascenzo, Fabrizio, Dichtl, Wolfgang, Burgdorf, Christof, Kherad, Behrouz, Tschoepe, Carsten, Sarcon, Annahita, Shinbane, Jerold, Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Karakas, Mahir, Koenig, Wolfgang, Pott, Alexander, Meyer, Philippe, Arroja, Jose David, Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Napp, L. Christian, Budnik, Monika, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Chan, Christina, Bridgman, Paul, Beug, Daniel, Delmas, Clement, Lairez, Olivier, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Kozel, Martin, Tousek, Petr, Winchester, David E., Galuszka, Jan, Ukena, Christian, Poglajen, Gregor, Carrilho-Ferreira, Pedro, Hauck, Christian, Paolini, Carla, Bilato, Claudio, Kobayashi, Yoshio, Prasad, Abhiram, Rihal, Charanjit S., Liu, Kan, Schulze, P. Christian, Bianco, Matteo, Joerg, Lucas, Rickli, Hans, Pestana, Goncalo, Nguyen, Thanh H., Boehm, Michael, Maier, Lars S., Pinto, Fausto J., Widimsky, Petr, Felix, Stephan B., Opolski, Grzegorz, Braun-Dullaeus, Ruediger C., Rottbauer, Wolfgang, Hasenfuss, Gerd, Pieske, Burkert M., Schunkert, Heribert, Thiele, Holger, Bauersachs, Johann, Katus, Hugo A., Horowitz, John D., Di Mario, Carlo, Muenzel, Thomas, Crea, Filippo, Bax, Jeroen J., Luescher, Thomas F., Ruschitzka, Frank, Duru, Firat, Borggrefe, Martin, Ghadri, Jelena R., Akin, Ibrahim, Templin, Christian, El-Battrawy, Ibrahim, Cammann, Victoria L., Kato, Ken, Szawan, Konrad A., Di Vece, Davide, Rossi, Aurelio, Wischnewsky, Manfred, Hermes-Laufer, Julia, Gili, Sebastiano, Citro, Rodolfo, Bossone, Eduardo, Neuhaus, Michael, Franke, Jennifer, Meder, Benjamin, Jaguszewski, Milosz, Noutsias, Michel, Knorr, Maike, Heiner, Susanne, D'Ascenzo, Fabrizio, Dichtl, Wolfgang, Burgdorf, Christof, Kherad, Behrouz, Tschoepe, Carsten, Sarcon, Annahita, Shinbane, Jerold, Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Karakas, Mahir, Koenig, Wolfgang, Pott, Alexander, Meyer, Philippe, Arroja, Jose David, Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Napp, L. Christian, Budnik, Monika, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Chan, Christina, Bridgman, Paul, Beug, Daniel, Delmas, Clement, Lairez, Olivier, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Kozel, Martin, Tousek, Petr, Winchester, David E., Galuszka, Jan, Ukena, Christian, Poglajen, Gregor, Carrilho-Ferreira, Pedro, Hauck, Christian, Paolini, Carla, Bilato, Claudio, Kobayashi, Yoshio, Prasad, Abhiram, Rihal, Charanjit S., Liu, Kan, Schulze, P. Christian, Bianco, Matteo, Joerg, Lucas, Rickli, Hans, Pestana, Goncalo, Nguyen, Thanh H., Boehm, Michael, Maier, Lars S., Pinto, Fausto J., Widimsky, Petr, Felix, Stephan B., Opolski, Grzegorz, Braun-Dullaeus, Ruediger C., Rottbauer, Wolfgang, Hasenfuss, Gerd, Pieske, Burkert M., Schunkert, Heribert, Thiele, Holger, Bauersachs, Johann, Katus, Hugo A., Horowitz, John D., Di Mario, Carlo, Muenzel, Thomas, Crea, Filippo, Bax, Jeroen J., Luescher, Thomas F., Ruschitzka, Frank, Duru, Firat, Borggrefe, Martin, Ghadri, Jelena R., Akin, Ibrahim, and Templin, Christian
Abstract: Background Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS. Methods and Results Patients with TTS were enrolled from the International Takotsubo Registry, which is a multinational network with 26 participating centers in Europe and the United States. Patients were dichotomized according to the presence or absence of AF at the time of admission. Of 1584 patients with TTS, 112 (7.1%) had AF. The mean age was higher (P<0.001), and there were fewer women (P=0.046) in the AF than in the non-AF group. Left ventricular ejection fraction was significantly lower (P=0.001), and cardiogenic shock was more often observed (P<0.001) in the AF group. Both in-hospital (P<0.001) and long-term mortality (P<0.001) were higher in the AF group. Multivariable Cox regression analysis revealed that AF was independently associated with higher long-term mortality (hazard ratio, 2.31; 95% CI, 1.50-3.55; P<0.001). Among patients with AF on admission, 42% had no known history of AF before the acute TTS event, and such patients had comparable in-hospital and long-term outcomes compared with those with a history of AF. Conclusions In patients presenting with TTS, AF on admission is significantly associated with increased in-hospital and long-term mortality rates. Whether antiarrhythmics and/or cardioversion are beneficial in TTS with AF should thus be tested in a future trial. Registration URL: ; Unique identifier: NCT01947621.
Published: 2021

4. Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry

Author: El-Battrawy, Ibrahim, Cammann, Victoria L., Kato, Ken, Szawan, Konrad A., Di Vece, Davide, Rossi, Aurelio, Wischnewsky, Manfred, Hermes-Laufer, Julia, Gili, Sebastiano, Citro, Rodolfo, Bossone, Eduardo, Neuhaus, Michael, Franke, Jennifer, Meder, Benjamin, Jaguszewski, Milosz, Noutsias, Michel, Knorr, Maike, Heiner, Susanne, D'Ascenzo, Fabrizio, Dichtl, Wolfgang, Burgdorf, Christof, Kherad, Behrouz, Tschoepe, Carsten, Sarcon, Annahita, Shinbane, Jerold, Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Karakas, Mahir, Koenig, Wolfgang, Pott, Alexander, Meyer, Philippe, Arroja, Jose David, Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Napp, L. Christian, Budnik, Monika, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Chan, Christina, Bridgman, Paul, Beug, Daniel, Delmas, Clement, Lairez, Olivier, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Kozel, Martin, Tousek, Petr, Winchester, David E., Galuszka, Jan, Ukena, Christian, Poglajen, Gregor, Carrilho-Ferreira, Pedro, Hauck, Christian, Paolini, Carla, Bilato, Claudio, Kobayashi, Yoshio, Prasad, Abhiram, Rihal, Charanjit S., Liu, Kan, Schulze, P. Christian, Bianco, Matteo, Joerg, Lucas, Rickli, Hans, Pestana, Goncalo, Nguyen, Thanh H., Boehm, Michael, Maier, Lars S., Pinto, Fausto J., Widimsky, Petr, Felix, Stephan B., Opolski, Grzegorz, Braun-Dullaeus, Ruediger C., Rottbauer, Wolfgang, Hasenfuss, Gerd, Pieske, Burkert M., Schunkert, Heribert, Thiele, Holger, Bauersachs, Johann, Katus, Hugo A., Horowitz, John D., Di Mario, Carlo, Muenzel, Thomas, Crea, Filippo, Bax, Jeroen J., Luescher, Thomas F., Ruschitzka, Frank, Duru, Firat, Borggrefe, Martin, Ghadri, Jelena R., Akin, Ibrahim, Templin, Christian, El-Battrawy, Ibrahim, Cammann, Victoria L., Kato, Ken, Szawan, Konrad A., Di Vece, Davide, Rossi, Aurelio, Wischnewsky, Manfred, Hermes-Laufer, Julia, Gili, Sebastiano, Citro, Rodolfo, Bossone, Eduardo, Neuhaus, Michael, Franke, Jennifer, Meder, Benjamin, Jaguszewski, Milosz, Noutsias, Michel, Knorr, Maike, Heiner, Susanne, D'Ascenzo, Fabrizio, Dichtl, Wolfgang, Burgdorf, Christof, Kherad, Behrouz, Tschoepe, Carsten, Sarcon, Annahita, Shinbane, Jerold, Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Karakas, Mahir, Koenig, Wolfgang, Pott, Alexander, Meyer, Philippe, Arroja, Jose David, Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Napp, L. Christian, Budnik, Monika, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Chan, Christina, Bridgman, Paul, Beug, Daniel, Delmas, Clement, Lairez, Olivier, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Kozel, Martin, Tousek, Petr, Winchester, David E., Galuszka, Jan, Ukena, Christian, Poglajen, Gregor, Carrilho-Ferreira, Pedro, Hauck, Christian, Paolini, Carla, Bilato, Claudio, Kobayashi, Yoshio, Prasad, Abhiram, Rihal, Charanjit S., Liu, Kan, Schulze, P. Christian, Bianco, Matteo, Joerg, Lucas, Rickli, Hans, Pestana, Goncalo, Nguyen, Thanh H., Boehm, Michael, Maier, Lars S., Pinto, Fausto J., Widimsky, Petr, Felix, Stephan B., Opolski, Grzegorz, Braun-Dullaeus, Ruediger C., Rottbauer, Wolfgang, Hasenfuss, Gerd, Pieske, Burkert M., Schunkert, Heribert, Thiele, Holger, Bauersachs, Johann, Katus, Hugo A., Horowitz, John D., Di Mario, Carlo, Muenzel, Thomas, Crea, Filippo, Bax, Jeroen J., Luescher, Thomas F., Ruschitzka, Frank, Duru, Firat, Borggrefe, Martin, Ghadri, Jelena R., Akin, Ibrahim, and Templin, Christian
Abstract: Background Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS. Methods and Results Patients with TTS were enrolled from the International Takotsubo Registry, which is a multinational network with 26 participating centers in Europe and the United States. Patients were dichotomized according to the presence or absence of AF at the time of admission. Of 1584 patients with TTS, 112 (7.1%) had AF. The mean age was higher (P<0.001), and there were fewer women (P=0.046) in the AF than in the non-AF group. Left ventricular ejection fraction was significantly lower (P=0.001), and cardiogenic shock was more often observed (P<0.001) in the AF group. Both in-hospital (P<0.001) and long-term mortality (P<0.001) were higher in the AF group. Multivariable Cox regression analysis revealed that AF was independently associated with higher long-term mortality (hazard ratio, 2.31; 95% CI, 1.50-3.55; P<0.001). Among patients with AF on admission, 42% had no known history of AF before the acute TTS event, and such patients had comparable in-hospital and long-term outcomes compared with those with a history of AF. Conclusions In patients presenting with TTS, AF on admission is significantly associated with increased in-hospital and long-term mortality rates. Whether antiarrhythmics and/or cardioversion are beneficial in TTS with AF should thus be tested in a future trial. Registration URL: ; Unique identifier: NCT01947621.
Published: 2021

5. European position paper on the management of patients with patent foramen ovale:Part II - Decompression sickness, migraine, arterial deoxygenation syndromes and select high-risk clinical conditions

Author: Pristipino, Christian, Germonpré, Peter, Toni, Danilo, Sievert, Horst, Meier, Bernhard, D'Ascenzo, Fabrizio, Berti, Sergio, Onorato, Eustaquio Maria, Bedogni, Francesco, Mas, Jean-Louis, Scacciatella, Paolo, Hildick-Smith, David, Gaita, Fiorenzo, Kyrle, Paul A., Thomson, John, Derumeaux, Genevieve, Sibbing, Dirk, Chessa, Massimo, Hornung, Marius, Zamorano, Jose, Dudek, Dariusz, Omedè, Pierluigi, Ballocca, Flavia, Barbero, Umberto, Giordana, Francesca, Gili, Sebastiano, Iannaccone, Mario, Akagi, Teiji, Anzola, Gianpaolo, Carroll, John, Dalvi, Bharat, De Angelis, Claudio, Junbo, Ge, Kasner, Scott E, Michel-Behnke, Ina, Musumeci, Giuseppe, Søndergaard, Lars, Tarantini, Giuseppe, Biondi-Zoccai, Giuseppe G. L., Capodanno, Davide, Valgimigli, Marco, Byrne, Robert, Kunadian, Vijay, Pristipino, Christian, Germonpré, Peter, Toni, Danilo, Sievert, Horst, Meier, Bernhard, D'Ascenzo, Fabrizio, Berti, Sergio, Onorato, Eustaquio Maria, Bedogni, Francesco, Mas, Jean-Louis, Scacciatella, Paolo, Hildick-Smith, David, Gaita, Fiorenzo, Kyrle, Paul A., Thomson, John, Derumeaux, Genevieve, Sibbing, Dirk, Chessa, Massimo, Hornung, Marius, Zamorano, Jose, Dudek, Dariusz, Omedè, Pierluigi, Ballocca, Flavia, Barbero, Umberto, Giordana, Francesca, Gili, Sebastiano, Iannaccone, Mario, Akagi, Teiji, Anzola, Gianpaolo, Carroll, John, Dalvi, Bharat, De Angelis, Claudio, Junbo, Ge, Kasner, Scott E, Michel-Behnke, Ina, Musumeci, Giuseppe, Søndergaard, Lars, Tarantini, Giuseppe, Biondi-Zoccai, Giuseppe G. L., Capodanno, Davide, Valgimigli, Marco, Byrne, Robert, and Kunadian, Vijay
Abstract: Patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions but to date only one official position paper related to left circulation thromboembolism has been published. This interdisciplinary paper, prepared with the involvement of eight European scientific societies, reviews the available evidence and proposes a rationale for decision making for other PFO-related clinical conditions. In order to guarantee a strict evidence-based process, we used a modified grading of recommendations, assessment, development, and evaluation (GRADE) methodology. A critical qualitative and quantitative evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk/benefit ratio. The level of evidence and the strength of the position statements were weighed and graded according to predefined scales. Despite being based on limited and observational or low-certainty randomised data, a number of position statements were made to frame PFO management in different clinical settings, along with suggestions for new research avenues. This interdisciplinary position paper, recognising the low or very low certainty of existing evidence, provides the first approach to several PFO-related clinical scenarios beyond left circulation thromboembolism and strongly stresses the need for fresh high-quality evidence on these topics.
Published: 2021

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

Author: Kato, Ken, Cammann, Victoria L, Napp, L Christian, Szawan, Konrad A, Micek, Jozef, Dreiding, Sara, Levinson, Rena A, Petkova, Vanya, Würdinger, Michael, Patrascu, Alexandru, Sumalinog, Rafael, Gili, Sebastiano; https://orcid.org/0000-0002-0542-0448, Clarenbach, Christian F; https://orcid.org/0000-0003-2158-2321, Kohler, Malcolm; https://orcid.org/0000-0003-1800-8003, et al, Lüscher, Thomas F; https://orcid.org/0000-0002-5259-538X, Ruschitzka, Frank; https://orcid.org/0000-0001-5972-0596, Ghadri, Jelena R, Templin, Christian; https://orcid.org/0000-0003-0287-4193, Kato, Ken, Cammann, Victoria L, Napp, L Christian, Szawan, Konrad A, Micek, Jozef, Dreiding, Sara, Levinson, Rena A, Petkova, Vanya, Würdinger, Michael, Patrascu, Alexandru, Sumalinog, Rafael, Gili, Sebastiano; https://orcid.org/0000-0002-0542-0448, Clarenbach, Christian F; https://orcid.org/0000-0003-2158-2321, Kohler, Malcolm; https://orcid.org/0000-0003-1800-8003, et al, Lüscher, Thomas F; https://orcid.org/0000-0002-5259-538X, Ruschitzka, Frank; https://orcid.org/0000-0001-5972-0596, Ghadri, Jelena R, and Templin, Christian; https://orcid.org/0000-0003-0287-4193
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.
Published: 2021

7. Prognostically relevant periprocedural myocardial injury and infarction associated with percutaneous coronary interventions: A Consensus Document of the ESC Working Group on Cellular Biology of the Heart and European Association of Percutaneous Cardiovascular Interventions (EAPCI)

Author: Onderzoek Cardiovasculair Reg. Med., Circulatory Health, Regenerative Medicine and Stem Cells, Team Medisch, Bulluck, Heerajnarain, Paradies, Valeria, Barbato, Emanuele, Baumbach, Andreas, Bøtker, Hans Erik, Capodanno, Davide, De Caterina, Raffaele, Cavallini, Claudio, Davidson, Sean M., Feldman, Dmitriy N., Ferdinandy, Péter, Gili, Sebastiano, Gyöngyösi, Mariann, Kunadian, Vijay, Ooi, Sze Yuan, Madonna, Rosalinda, Marber, Michael, Mehran, Roxana, Ndrepepa, Gjin, Perrino, Cinzia, Schüpke, Stefanie, Silvain, Johanne, Sluijter, Joost P.G., Tarantini, Giuseppe, Toth, Gabor G., Van Laake, Linda W., Von Birgelen, Clemens, Zeitouni, Michel, Jaffe, Allan S., Thygesen, Kristian, Hausenloy, Derek J., Onderzoek Cardiovasculair Reg. Med., Circulatory Health, Regenerative Medicine and Stem Cells, Team Medisch, Bulluck, Heerajnarain, Paradies, Valeria, Barbato, Emanuele, Baumbach, Andreas, Bøtker, Hans Erik, Capodanno, Davide, De Caterina, Raffaele, Cavallini, Claudio, Davidson, Sean M., Feldman, Dmitriy N., Ferdinandy, Péter, Gili, Sebastiano, Gyöngyösi, Mariann, Kunadian, Vijay, Ooi, Sze Yuan, Madonna, Rosalinda, Marber, Michael, Mehran, Roxana, Ndrepepa, Gjin, Perrino, Cinzia, Schüpke, Stefanie, Silvain, Johanne, Sluijter, Joost P.G., Tarantini, Giuseppe, Toth, Gabor G., Van Laake, Linda W., Von Birgelen, Clemens, Zeitouni, Michel, Jaffe, Allan S., Thygesen, Kristian, and Hausenloy, Derek J.
Published: 2021

8. Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry

Author: El-Battrawy, Ibrahim, Cammann, Victoria L, Kato, Ken, Szawan, Konrad A, Di Vece, Davide, Rossi, Aurelio, Wischnewsky, Manfred, Hermes-Laufer, Julia, Gili, Sebastiano, Citro, Rodolfo, Bossone, Eduardo, Neuhaus, Michael, Franke, Jennifer, Meder, Benjamin, Jaguszewski, Milosz, Noutsias, Michel, Knorr, Maike, Heiner, Susanne, D'Ascenzo, Fabrizio, Dichtl, Wolfgang, Burgdorf, Christof, Kherad, Behrouz, Tschöpe, Carsten, Sarcon, Annahita, Shinbane, Jerold, Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, et al, El-Battrawy, Ibrahim, Cammann, Victoria L, Kato, Ken, Szawan, Konrad A, Di Vece, Davide, Rossi, Aurelio, Wischnewsky, Manfred, Hermes-Laufer, Julia, Gili, Sebastiano, Citro, Rodolfo, Bossone, Eduardo, Neuhaus, Michael, Franke, Jennifer, Meder, Benjamin, Jaguszewski, Milosz, Noutsias, Michel, Knorr, Maike, Heiner, Susanne, D'Ascenzo, Fabrizio, Dichtl, Wolfgang, Burgdorf, Christof, Kherad, Behrouz, Tschöpe, Carsten, Sarcon, Annahita, Shinbane, Jerold, Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, and et al
Abstract: Background Atrial fibrillation (AF) is a major risk factor for mortality. The prevalence, clinical correlates, and prognostic impact of AF in Takotsubo syndrome (TTS) have not yet been investigated in a large patient cohort. This study aimed to investigate the prevalence, clinical correlates, and prognostic impact of AF in patients with TTS. Methods and Results Patients with TTS were enrolled from the International Takotsubo Registry, which is a multinational network with 26 participating centers in Europe and the United States. Patients were dichotomized according to the presence or absence of AF at the time of admission. Of 1584 patients with TTS, 112 (7.1%) had AF. The mean age was higher (P<0.001), and there were fewer women (P=0.046) in the AF than in the non-AF group. Left ventricular ejection fraction was significantly lower (P=0.001), and cardiogenic shock was more often observed (P<0.001) in the AF group. Both in-hospital (P<0.001) and long-term mortality (P<0.001) were higher in the AF group. Multivariable Cox regression analysis revealed that AF was independently associated with higher long-term mortality (hazard ratio, 2.31; 95% CI, 1.50-3.55; P<0.001). Among patients with AF on admission, 42% had no known history of AF before the acute TTS event, and such patients had comparable in-hospital and long-term outcomes compared with those with a history of AF. Conclusions In patients presenting with TTS, AF on admission is significantly associated with increased in-hospital and long-term mortality rates. Whether antiarrhythmics and/or cardioversion are beneficial in TTS with AF should thus be tested in a future trial. Registration URL: https://www.clinicaltrials.gov; Unique identifier: NCT01947621.
Published: 2021

9. Impact of aspirin on takotsubo syndrome: a propensity score-based analysis of the InterTAK Registry

Author: D'Ascenzo, Fabrizio, Gili, Sebastiano, Bertaina, Maurizio, Iannaccone, Mario, Cammann, Victoria L., Di Vece, Davide, Kato, Ken, Saglietto, Andrea, Szawan, Konrad A., Frangieh, Antonio H., Boffini, Beatrice, Annaratone, Margherita, Sarcon, Annahita, Levinson, Rena A., Franke, Jennifer, Napp, L. Christian, Jaguszewski, Milosz, Noutsias, Michel, Muenzel, Thomas, Knorr, Maike, Heiner, Susanne, Katus, Hugo A., Burgdorf, Christof, Schunkert, Heribert, Thiele, Holger, Bauersachs, Johann, Tschoepe, Carsten, Pieske, Burkert M., Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Hasenfuss, Gerd, Karakas, Mahir, Koenig, Wolfgang, Rottbauer, Wolfgang, Said, Samir M., Braun-Dullaeus, Ruediger C., Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Opolski, Grzegorz, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Crea, Filippo, Dichtl, Wolfgang, Franz, Wolfgang M., Empen, Klaus, Felix, Stephan B., Delmas, Clement, Lairez, Olivier, El-Battrawy, Ibrahim, Akin, Ibrahim, Borggrefe, Martin, Horowitz, John D., Kozel, Martin, Tousek, Petr, Widimsky, Petr, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Biondi-Zoccai, Giuseppe, Winchester, David E., Ukena, Christian, Neuhaus, Michael, Bax, Jeroen J., Prasad, Abhiram, Di Mario, Carlo, Boehm, Michael, Gasparini, Mauro, Ruschitzka, Frank, Bossone, Eduardo, Citro, Rodolfo, Rinaldi, Mauro, De Ferrari, Gaetano Maria, Luscher, Thomas, Ghadri, Jelena R., Templin, Christian, D'Ascenzo, Fabrizio, Gili, Sebastiano, Bertaina, Maurizio, Iannaccone, Mario, Cammann, Victoria L., Di Vece, Davide, Kato, Ken, Saglietto, Andrea, Szawan, Konrad A., Frangieh, Antonio H., Boffini, Beatrice, Annaratone, Margherita, Sarcon, Annahita, Levinson, Rena A., Franke, Jennifer, Napp, L. Christian, Jaguszewski, Milosz, Noutsias, Michel, Muenzel, Thomas, Knorr, Maike, Heiner, Susanne, Katus, Hugo A., Burgdorf, Christof, Schunkert, Heribert, Thiele, Holger, Bauersachs, Johann, Tschoepe, Carsten, Pieske, Burkert M., Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Hasenfuss, Gerd, Karakas, Mahir, Koenig, Wolfgang, Rottbauer, Wolfgang, Said, Samir M., Braun-Dullaeus, Ruediger C., Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Opolski, Grzegorz, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Crea, Filippo, Dichtl, Wolfgang, Franz, Wolfgang M., Empen, Klaus, Felix, Stephan B., Delmas, Clement, Lairez, Olivier, El-Battrawy, Ibrahim, Akin, Ibrahim, Borggrefe, Martin, Horowitz, John D., Kozel, Martin, Tousek, Petr, Widimsky, Petr, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Biondi-Zoccai, Giuseppe, Winchester, David E., Ukena, Christian, Neuhaus, Michael, Bax, Jeroen J., Prasad, Abhiram, Di Mario, Carlo, Boehm, Michael, Gasparini, Mauro, Ruschitzka, Frank, Bossone, Eduardo, Citro, Rodolfo, Rinaldi, Mauro, De Ferrari, Gaetano Maria, Luscher, Thomas, Ghadri, Jelena R., and Templin, Christian
Abstract: AimsThe aim of the present study was to investigate the impact of aspirin on prognosis in takotsubo syndrome (TTS). Methods and resultsPatients from the International Takotsubo (InterTAK) Registry were categorized into two groups based on aspirin prescription at discharge. A comparison of clinical outcomes between groups was performed using an adjusted analysis with propensity score (PS) stratification; results from the unadjusted analysis were also reported to note the effect of the PS adjustment. Major adverse cardiac and cerebrovascular events (MACCE: a composite of death, myocardial infarction, TTS recurrence, stroke or transient ischaemic attack) were assessed at 30-day and 5-year follow-up. A total of 1533 TTS patients with known status regarding aspirin prescription at discharge were included. According to the adjusted analysis based on PS stratification, aspirin was not associated with a lower hazard of MACCE at 30-day [hazard ratio (HR) 1.24, 95% confidence interval (CI) 0.50-3.04, P = 0.64] or 5-year follow-up (HR 1.11, 95% CI 0.78-1.58, P = 0.58). These results were confirmed by sensitivity analyses performed with alternative PS-based methods, i.e. covariate adjustment and inverse probability of treatment weighting. ConclusionIn the present study, no association was found between aspirin use in TTS patients and a reduced risk of MACCE at 30-day and 5-year follow-up. These findings should be confirmed in adequately powered randomized controlled trials. Identifier: NCT01947621.
Published: 2020

10. Age -Related Variations in Takotsubo Syndrome

Author: Cammann, Victoria L., Szawan, Konrad A., Stahli, Barbara E., Kato, Ken, Budnik, Monika, Wischnewsky, Manfred, Dreiding, Sara, Levinson, Rena A., Di Vece, Davide, Gili, Sebastiano, Citro, Rodolfo, Bossone, Eduardo, Neuhaus, Michael, Franke, Jennifer, Meder, Benjamin, Jaguszewski, Milosz, Noutsias, Michel, Knorr, Maike, Heiner, Susanne, D'Ascenzo, Fabrizio, Dichtl, Wolfgang, Burgdorf, Christof, Kherad, Behrouz, Tschope, Carsten, Sarcon, Annahita, Shinbane, Jerold, Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Karakas, Mahir, Koenig, Wolfgang, Pott, Alexander, Meyer, Philippe, Roffi, Marco, Banning, Adrian, Wolfrum, Mathias, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Napp, L. Christian, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Chan, Christina, Bridgman, Paul, Beug, Daniel, Delmas, Clement, Lairez, Olivier, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, El-Battrawy, Ibrahim, Akin, Ibrahim, Polednikova, Karolina, Tous, Petr, Winchester, David E., Galuszka, Jan, Ukena, Christian, Poglajen, Gregor, Carrilho-Ferreira, Pedro, Hauck, Christian, Paolini, Carla, Bilato, Claudio, Kobayashi, Yoshio, Shoji, Toshihiro, Ishibashi, Iwao, Takahara, Masayuki, Himi, Toshiharu, Din, Jehangir, Al-Shammari, Ali, Prasad, Abhiram, Rihal, Charanjit S., Liu, Kan, Schulze, P. Christian, Bianco, Matteo, Jorg, Lucas, Rickli, Hans, Pestana, Goncalo, Nguyen, Thanh H., Bohm, Michael, Maier, Lars S., Pinto, Fausto J., Widimsky, Petr, Felix, Stephan B., Braun-Dullaeus, Ruediger C., Rottbauer, Wolfgang, Hasenfuss, Gerd, Pieske, Burkert M., Schunkert, Heribert, Borggrefe, Martin, Thiele, Holger, Bauersachs, Johann, Katus, Hugo A., Horowitz, John D., Di Mario, Carlo, Muenzel, Thomas, Crea, Filippo, Bax, Jeroen J., Luscher, Thomas F., Ruschitzka, Frank, Ghadri, Jelena R., Opolski, Grzegorz, Templin, Christian, Cammann, Victoria L., Szawan, Konrad A., Stahli, Barbara E., Kato, Ken, Budnik, Monika, Wischnewsky, Manfred, Dreiding, Sara, Levinson, Rena A., Di Vece, Davide, Gili, Sebastiano, Citro, Rodolfo, Bossone, Eduardo, Neuhaus, Michael, Franke, Jennifer, Meder, Benjamin, Jaguszewski, Milosz, Noutsias, Michel, Knorr, Maike, Heiner, Susanne, D'Ascenzo, Fabrizio, Dichtl, Wolfgang, Burgdorf, Christof, Kherad, Behrouz, Tschope, Carsten, Sarcon, Annahita, Shinbane, Jerold, Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Karakas, Mahir, Koenig, Wolfgang, Pott, Alexander, Meyer, Philippe, Roffi, Marco, Banning, Adrian, Wolfrum, Mathias, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Napp, L. Christian, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Chan, Christina, Bridgman, Paul, Beug, Daniel, Delmas, Clement, Lairez, Olivier, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, El-Battrawy, Ibrahim, Akin, Ibrahim, Polednikova, Karolina, Tous, Petr, Winchester, David E., Galuszka, Jan, Ukena, Christian, Poglajen, Gregor, Carrilho-Ferreira, Pedro, Hauck, Christian, Paolini, Carla, Bilato, Claudio, Kobayashi, Yoshio, Shoji, Toshihiro, Ishibashi, Iwao, Takahara, Masayuki, Himi, Toshiharu, Din, Jehangir, Al-Shammari, Ali, Prasad, Abhiram, Rihal, Charanjit S., Liu, Kan, Schulze, P. Christian, Bianco, Matteo, Jorg, Lucas, Rickli, Hans, Pestana, Goncalo, Nguyen, Thanh H., Bohm, Michael, Maier, Lars S., Pinto, Fausto J., Widimsky, Petr, Felix, Stephan B., Braun-Dullaeus, Ruediger C., Rottbauer, Wolfgang, Hasenfuss, Gerd, Pieske, Burkert M., Schunkert, Heribert, Borggrefe, Martin, Thiele, Holger, Bauersachs, Johann, Katus, Hugo A., Horowitz, John D., Di Mario, Carlo, Muenzel, Thomas, Crea, Filippo, Bax, Jeroen J., Luscher, Thomas F., Ruschitzka, Frank, Ghadri, Jelena R., Opolski, Grzegorz, and Templin, Christian
Published: 2020

11. Coexistence and outcome of coronary artery disease in Takotsubo syndrome

Author: Napp, L. Christian, Cammann, Victoria L., Jaguszewski, Milosz, Szawan, Konrad A., Wischnewsky, Manfred, Gili, Sebastiano, Knorr, Maike, Heiner, Susanne, Citro, Rodolfo, Bossone, Eduardo, D'Ascenzo, Fabrizio, Neuhaus, Michael, Franke, Jennifer, Sorici-Barb, Ioana, Noutsias, Michel, Burgdorf, Christof, Koenig, Wolfgang, Kherad, Behrouz, Sarcon, Annahita, Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Karakas, Mahir, Pott, Alexander, Meyer, Philippe, Arroja, Jose D., Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Hauck, Christian, Paolini, Carla, Bilato, Claudio, Imori, Yoichi, Kato, Ken, Kobayashi, Yoshio, Opolski, Grzegorz, Budnik, Monika, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Dichtl, Wolfgang, Chan, Christina, Bridgman, Paul, Beug, Daniel, Delmas, Clement, Lairez, Olivier, El-Battrawy, Ibrahim, Akin, Ibrahim, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Horowitz, John D., Polednikova, Karolina, Tousek, Petr, Widimsky, Petr, Winchester, David E., Galuszka, Jan, Ukena, Christian, Poglajen, Gregor, Carrilho-Ferreira, Pedro, Di Mario, Carlo, Prasad, Abhiram, Rihal, Charanjit S., Schulze, P. Christian, Bianco, Matteo, Crea, Filippo, Borggrefe, Martin, Maier, Lars S., Pinto, Fausto J., Braun-Dullaeus, Ruediger C., Rottbauer, Wolfgang, Katus, Hugo A., Hasenfuss, Gerd, Tschoepe, Carsten, Pieske, Burkert M., Thiele, Holger, Schunkert, Heribert, Boehm, Michael, Felix, Stephan B., Muenzel, Thomas, Bax, Jeroen J., Bauersachs, Johann, Braunwald, Eugene, Luescher, Thomas F., Ruschitzka, Frank, Ghadri, Jelena R., Templin, Christian, Napp, L. Christian, Cammann, Victoria L., Jaguszewski, Milosz, Szawan, Konrad A., Wischnewsky, Manfred, Gili, Sebastiano, Knorr, Maike, Heiner, Susanne, Citro, Rodolfo, Bossone, Eduardo, D'Ascenzo, Fabrizio, Neuhaus, Michael, Franke, Jennifer, Sorici-Barb, Ioana, Noutsias, Michel, Burgdorf, Christof, Koenig, Wolfgang, Kherad, Behrouz, Sarcon, Annahita, Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Karakas, Mahir, Pott, Alexander, Meyer, Philippe, Arroja, Jose D., Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Hauck, Christian, Paolini, Carla, Bilato, Claudio, Imori, Yoichi, Kato, Ken, Kobayashi, Yoshio, Opolski, Grzegorz, Budnik, Monika, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Dichtl, Wolfgang, Chan, Christina, Bridgman, Paul, Beug, Daniel, Delmas, Clement, Lairez, Olivier, El-Battrawy, Ibrahim, Akin, Ibrahim, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Horowitz, John D., Polednikova, Karolina, Tousek, Petr, Widimsky, Petr, Winchester, David E., Galuszka, Jan, Ukena, Christian, Poglajen, Gregor, Carrilho-Ferreira, Pedro, Di Mario, Carlo, Prasad, Abhiram, Rihal, Charanjit S., Schulze, P. Christian, Bianco, Matteo, Crea, Filippo, Borggrefe, Martin, Maier, Lars S., Pinto, Fausto J., Braun-Dullaeus, Ruediger C., Rottbauer, Wolfgang, Katus, Hugo A., Hasenfuss, Gerd, Tschoepe, Carsten, Pieske, Burkert M., Thiele, Holger, Schunkert, Heribert, Boehm, Michael, Felix, Stephan B., Muenzel, Thomas, Bax, Jeroen J., Bauersachs, Johann, Braunwald, Eugene, Luescher, Thomas F., Ruschitzka, Frank, Ghadri, Jelena R., and Templin, Christian
Abstract: Aims Takotsubo syndrome (US) is an acute heart failure syndrome, which shares many features with acute coronary syndrome (ACS). Although TTS was initially described with angiographically normal coronary arteries, smaller studies recently indicated a potential coexistence of coronary artery disease (CAD) in US patients. This study aimed to determine the coexistence, features, and prognostic role of CAD in a large cohort of patients with US. Methods and results Coronary anatomy and CAD were studied in patients diagnosed with US. Inclusion criteria were compliance with the International Takotsubo Diagnostic Criteria for TTS, and availability of original coronary angiographies with ventriculography performed during the acute phase. Exclusion criteria were missing views, poor quality of angiography loops, and angiography without ventriculography. A total of 1016 US patients were studied. Of those, 23.0% had obstructive CAD, 41.2% had non -obstructive CAD, and 35.7% had angiographically normal coronary arteries. A total of 47 patients (4.6%) underwent percutaneous coronary intervention, and 3 patients had acute and 8 had chronic coronary artery occlusion concomitant with US, respectively. The presence of CAD was associated with increased incidence of shock, ventilation, and death from any cause. After adjusting for confounders, the presence of obstructive CAD was associated with mortality at 30 days. Takotsubo syndrome patients with obstructive CAD were at comparable risk for shock and death and nearly at twice the risk for ventilation compared to an age- and sex-matched ACS cohort. Conclusions Coronary artery disease frequently coexists in US patients, presents with the whole spectrum of coronary pathology including acute coronary occlusion, and is associated with adverse outcome.
Published: 2020

12. Impact of aspirin on takotsubo syndrome: a propensity score-based analysis of the InterTAK Registry

Author: D'Ascenzo, Fabrizio, Gili, Sebastiano, Bertaina, Maurizio, Iannaccone, Mario, Cammann, Victoria L., Di Vece, Davide, Kato, Ken, Saglietto, Andrea, Szawan, Konrad A., Frangieh, Antonio H., Boffini, Beatrice, Annaratone, Margherita, Sarcon, Annahita, Levinson, Rena A., Franke, Jennifer, Napp, L. Christian, Jaguszewski, Milosz, Noutsias, Michel, Muenzel, Thomas, Knorr, Maike, Heiner, Susanne, Katus, Hugo A., Burgdorf, Christof, Schunkert, Heribert, Thiele, Holger, Bauersachs, Johann, Tschoepe, Carsten, Pieske, Burkert M., Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Hasenfuss, Gerd, Karakas, Mahir, Koenig, Wolfgang, Rottbauer, Wolfgang, Said, Samir M., Braun-Dullaeus, Ruediger C., Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Opolski, Grzegorz, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Crea, Filippo, Dichtl, Wolfgang, Franz, Wolfgang M., Empen, Klaus, Felix, Stephan B., Delmas, Clement, Lairez, Olivier, El-Battrawy, Ibrahim, Akin, Ibrahim, Borggrefe, Martin, Horowitz, John D., Kozel, Martin, Tousek, Petr, Widimsky, Petr, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Biondi-Zoccai, Giuseppe, Winchester, David E., Ukena, Christian, Neuhaus, Michael, Bax, Jeroen J., Prasad, Abhiram, Di Mario, Carlo, Boehm, Michael, Gasparini, Mauro, Ruschitzka, Frank, Bossone, Eduardo, Citro, Rodolfo, Rinaldi, Mauro, De Ferrari, Gaetano Maria, Luscher, Thomas, Ghadri, Jelena R., Templin, Christian, D'Ascenzo, Fabrizio, Gili, Sebastiano, Bertaina, Maurizio, Iannaccone, Mario, Cammann, Victoria L., Di Vece, Davide, Kato, Ken, Saglietto, Andrea, Szawan, Konrad A., Frangieh, Antonio H., Boffini, Beatrice, Annaratone, Margherita, Sarcon, Annahita, Levinson, Rena A., Franke, Jennifer, Napp, L. Christian, Jaguszewski, Milosz, Noutsias, Michel, Muenzel, Thomas, Knorr, Maike, Heiner, Susanne, Katus, Hugo A., Burgdorf, Christof, Schunkert, Heribert, Thiele, Holger, Bauersachs, Johann, Tschoepe, Carsten, Pieske, Burkert M., Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Hasenfuss, Gerd, Karakas, Mahir, Koenig, Wolfgang, Rottbauer, Wolfgang, Said, Samir M., Braun-Dullaeus, Ruediger C., Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Opolski, Grzegorz, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Crea, Filippo, Dichtl, Wolfgang, Franz, Wolfgang M., Empen, Klaus, Felix, Stephan B., Delmas, Clement, Lairez, Olivier, El-Battrawy, Ibrahim, Akin, Ibrahim, Borggrefe, Martin, Horowitz, John D., Kozel, Martin, Tousek, Petr, Widimsky, Petr, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Biondi-Zoccai, Giuseppe, Winchester, David E., Ukena, Christian, Neuhaus, Michael, Bax, Jeroen J., Prasad, Abhiram, Di Mario, Carlo, Boehm, Michael, Gasparini, Mauro, Ruschitzka, Frank, Bossone, Eduardo, Citro, Rodolfo, Rinaldi, Mauro, De Ferrari, Gaetano Maria, Luscher, Thomas, Ghadri, Jelena R., and Templin, Christian
Abstract: AimsThe aim of the present study was to investigate the impact of aspirin on prognosis in takotsubo syndrome (TTS). Methods and resultsPatients from the International Takotsubo (InterTAK) Registry were categorized into two groups based on aspirin prescription at discharge. A comparison of clinical outcomes between groups was performed using an adjusted analysis with propensity score (PS) stratification; results from the unadjusted analysis were also reported to note the effect of the PS adjustment. Major adverse cardiac and cerebrovascular events (MACCE: a composite of death, myocardial infarction, TTS recurrence, stroke or transient ischaemic attack) were assessed at 30-day and 5-year follow-up. A total of 1533 TTS patients with known status regarding aspirin prescription at discharge were included. According to the adjusted analysis based on PS stratification, aspirin was not associated with a lower hazard of MACCE at 30-day [hazard ratio (HR) 1.24, 95% confidence interval (CI) 0.50-3.04, P = 0.64] or 5-year follow-up (HR 1.11, 95% CI 0.78-1.58, P = 0.58). These results were confirmed by sensitivity analyses performed with alternative PS-based methods, i.e. covariate adjustment and inverse probability of treatment weighting. ConclusionIn the present study, no association was found between aspirin use in TTS patients and a reduced risk of MACCE at 30-day and 5-year follow-up. These findings should be confirmed in adequately powered randomized controlled trials. Identifier: NCT01947621.
Published: 2020

13. Age -Related Variations in Takotsubo Syndrome

Author: Cammann, Victoria L., Szawan, Konrad A., Stahli, Barbara E., Kato, Ken, Budnik, Monika, Wischnewsky, Manfred, Dreiding, Sara, Levinson, Rena A., Di Vece, Davide, Gili, Sebastiano, Citro, Rodolfo, Bossone, Eduardo, Neuhaus, Michael, Franke, Jennifer, Meder, Benjamin, Jaguszewski, Milosz, Noutsias, Michel, Knorr, Maike, Heiner, Susanne, D'Ascenzo, Fabrizio, Dichtl, Wolfgang, Burgdorf, Christof, Kherad, Behrouz, Tschope, Carsten, Sarcon, Annahita, Shinbane, Jerold, Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Karakas, Mahir, Koenig, Wolfgang, Pott, Alexander, Meyer, Philippe, Roffi, Marco, Banning, Adrian, Wolfrum, Mathias, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Napp, L. Christian, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Chan, Christina, Bridgman, Paul, Beug, Daniel, Delmas, Clement, Lairez, Olivier, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, El-Battrawy, Ibrahim, Akin, Ibrahim, Polednikova, Karolina, Tous, Petr, Winchester, David E., Galuszka, Jan, Ukena, Christian, Poglajen, Gregor, Carrilho-Ferreira, Pedro, Hauck, Christian, Paolini, Carla, Bilato, Claudio, Kobayashi, Yoshio, Shoji, Toshihiro, Ishibashi, Iwao, Takahara, Masayuki, Himi, Toshiharu, Din, Jehangir, Al-Shammari, Ali, Prasad, Abhiram, Rihal, Charanjit S., Liu, Kan, Schulze, P. Christian, Bianco, Matteo, Jorg, Lucas, Rickli, Hans, Pestana, Goncalo, Nguyen, Thanh H., Bohm, Michael, Maier, Lars S., Pinto, Fausto J., Widimsky, Petr, Felix, Stephan B., Braun-Dullaeus, Ruediger C., Rottbauer, Wolfgang, Hasenfuss, Gerd, Pieske, Burkert M., Schunkert, Heribert, Borggrefe, Martin, Thiele, Holger, Bauersachs, Johann, Katus, Hugo A., Horowitz, John D., Di Mario, Carlo, Muenzel, Thomas, Crea, Filippo, Bax, Jeroen J., Luscher, Thomas F., Ruschitzka, Frank, Ghadri, Jelena R., Opolski, Grzegorz, Templin, Christian, Cammann, Victoria L., Szawan, Konrad A., Stahli, Barbara E., Kato, Ken, Budnik, Monika, Wischnewsky, Manfred, Dreiding, Sara, Levinson, Rena A., Di Vece, Davide, Gili, Sebastiano, Citro, Rodolfo, Bossone, Eduardo, Neuhaus, Michael, Franke, Jennifer, Meder, Benjamin, Jaguszewski, Milosz, Noutsias, Michel, Knorr, Maike, Heiner, Susanne, D'Ascenzo, Fabrizio, Dichtl, Wolfgang, Burgdorf, Christof, Kherad, Behrouz, Tschope, Carsten, Sarcon, Annahita, Shinbane, Jerold, Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Karakas, Mahir, Koenig, Wolfgang, Pott, Alexander, Meyer, Philippe, Roffi, Marco, Banning, Adrian, Wolfrum, Mathias, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Napp, L. Christian, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Chan, Christina, Bridgman, Paul, Beug, Daniel, Delmas, Clement, Lairez, Olivier, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, El-Battrawy, Ibrahim, Akin, Ibrahim, Polednikova, Karolina, Tous, Petr, Winchester, David E., Galuszka, Jan, Ukena, Christian, Poglajen, Gregor, Carrilho-Ferreira, Pedro, Hauck, Christian, Paolini, Carla, Bilato, Claudio, Kobayashi, Yoshio, Shoji, Toshihiro, Ishibashi, Iwao, Takahara, Masayuki, Himi, Toshiharu, Din, Jehangir, Al-Shammari, Ali, Prasad, Abhiram, Rihal, Charanjit S., Liu, Kan, Schulze, P. Christian, Bianco, Matteo, Jorg, Lucas, Rickli, Hans, Pestana, Goncalo, Nguyen, Thanh H., Bohm, Michael, Maier, Lars S., Pinto, Fausto J., Widimsky, Petr, Felix, Stephan B., Braun-Dullaeus, Ruediger C., Rottbauer, Wolfgang, Hasenfuss, Gerd, Pieske, Burkert M., Schunkert, Heribert, Borggrefe, Martin, Thiele, Holger, Bauersachs, Johann, Katus, Hugo A., Horowitz, John D., Di Mario, Carlo, Muenzel, Thomas, Crea, Filippo, Bax, Jeroen J., Luscher, Thomas F., Ruschitzka, Frank, Ghadri, Jelena R., Opolski, Grzegorz, and Templin, Christian
Published: 2020

14. Coexistence and outcome of coronary artery disease in Takotsubo syndrome

Author: Napp, L. Christian, Cammann, Victoria L., Jaguszewski, Milosz, Szawan, Konrad A., Wischnewsky, Manfred, Gili, Sebastiano, Knorr, Maike, Heiner, Susanne, Citro, Rodolfo, Bossone, Eduardo, D'Ascenzo, Fabrizio, Neuhaus, Michael, Franke, Jennifer, Sorici-Barb, Ioana, Noutsias, Michel, Burgdorf, Christof, Koenig, Wolfgang, Kherad, Behrouz, Sarcon, Annahita, Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Karakas, Mahir, Pott, Alexander, Meyer, Philippe, Arroja, Jose D., Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Hauck, Christian, Paolini, Carla, Bilato, Claudio, Imori, Yoichi, Kato, Ken, Kobayashi, Yoshio, Opolski, Grzegorz, Budnik, Monika, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Dichtl, Wolfgang, Chan, Christina, Bridgman, Paul, Beug, Daniel, Delmas, Clement, Lairez, Olivier, El-Battrawy, Ibrahim, Akin, Ibrahim, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Horowitz, John D., Polednikova, Karolina, Tousek, Petr, Widimsky, Petr, Winchester, David E., Galuszka, Jan, Ukena, Christian, Poglajen, Gregor, Carrilho-Ferreira, Pedro, Di Mario, Carlo, Prasad, Abhiram, Rihal, Charanjit S., Schulze, P. Christian, Bianco, Matteo, Crea, Filippo, Borggrefe, Martin, Maier, Lars S., Pinto, Fausto J., Braun-Dullaeus, Ruediger C., Rottbauer, Wolfgang, Katus, Hugo A., Hasenfuss, Gerd, Tschoepe, Carsten, Pieske, Burkert M., Thiele, Holger, Schunkert, Heribert, Boehm, Michael, Felix, Stephan B., Muenzel, Thomas, Bax, Jeroen J., Bauersachs, Johann, Braunwald, Eugene, Luescher, Thomas F., Ruschitzka, Frank, Ghadri, Jelena R., Templin, Christian, Napp, L. Christian, Cammann, Victoria L., Jaguszewski, Milosz, Szawan, Konrad A., Wischnewsky, Manfred, Gili, Sebastiano, Knorr, Maike, Heiner, Susanne, Citro, Rodolfo, Bossone, Eduardo, D'Ascenzo, Fabrizio, Neuhaus, Michael, Franke, Jennifer, Sorici-Barb, Ioana, Noutsias, Michel, Burgdorf, Christof, Koenig, Wolfgang, Kherad, Behrouz, Sarcon, Annahita, Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Karakas, Mahir, Pott, Alexander, Meyer, Philippe, Arroja, Jose D., Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Hauck, Christian, Paolini, Carla, Bilato, Claudio, Imori, Yoichi, Kato, Ken, Kobayashi, Yoshio, Opolski, Grzegorz, Budnik, Monika, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Dichtl, Wolfgang, Chan, Christina, Bridgman, Paul, Beug, Daniel, Delmas, Clement, Lairez, Olivier, El-Battrawy, Ibrahim, Akin, Ibrahim, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Horowitz, John D., Polednikova, Karolina, Tousek, Petr, Widimsky, Petr, Winchester, David E., Galuszka, Jan, Ukena, Christian, Poglajen, Gregor, Carrilho-Ferreira, Pedro, Di Mario, Carlo, Prasad, Abhiram, Rihal, Charanjit S., Schulze, P. Christian, Bianco, Matteo, Crea, Filippo, Borggrefe, Martin, Maier, Lars S., Pinto, Fausto J., Braun-Dullaeus, Ruediger C., Rottbauer, Wolfgang, Katus, Hugo A., Hasenfuss, Gerd, Tschoepe, Carsten, Pieske, Burkert M., Thiele, Holger, Schunkert, Heribert, Boehm, Michael, Felix, Stephan B., Muenzel, Thomas, Bax, Jeroen J., Bauersachs, Johann, Braunwald, Eugene, Luescher, Thomas F., Ruschitzka, Frank, Ghadri, Jelena R., and Templin, Christian
Abstract: Aims Takotsubo syndrome (US) is an acute heart failure syndrome, which shares many features with acute coronary syndrome (ACS). Although TTS was initially described with angiographically normal coronary arteries, smaller studies recently indicated a potential coexistence of coronary artery disease (CAD) in US patients. This study aimed to determine the coexistence, features, and prognostic role of CAD in a large cohort of patients with US. Methods and results Coronary anatomy and CAD were studied in patients diagnosed with US. Inclusion criteria were compliance with the International Takotsubo Diagnostic Criteria for TTS, and availability of original coronary angiographies with ventriculography performed during the acute phase. Exclusion criteria were missing views, poor quality of angiography loops, and angiography without ventriculography. A total of 1016 US patients were studied. Of those, 23.0% had obstructive CAD, 41.2% had non -obstructive CAD, and 35.7% had angiographically normal coronary arteries. A total of 47 patients (4.6%) underwent percutaneous coronary intervention, and 3 patients had acute and 8 had chronic coronary artery occlusion concomitant with US, respectively. The presence of CAD was associated with increased incidence of shock, ventilation, and death from any cause. After adjusting for confounders, the presence of obstructive CAD was associated with mortality at 30 days. Takotsubo syndrome patients with obstructive CAD were at comparable risk for shock and death and nearly at twice the risk for ventilation compared to an age- and sex-matched ACS cohort. Conclusions Coronary artery disease frequently coexists in US patients, presents with the whole spectrum of coronary pathology including acute coronary occlusion, and is associated with adverse outcome.
Published: 2020

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

Author: Cammann, Victoria L., Sarcon, Annahita, Ding, Katharina J., Seifert, Burkhardt, Kato, Ken, Di Vece, Davide, Szawan, Konrad A., Gili, Sebastiano, Jurisic, Stjepan, Bacchi, Beatrice, Micek, Jozef, Frangieh, Antonio H., Napp, L. Christian, Jaguszewski, Milosz, Bossone, Eduardo, Citro, Rodolfo, D'Ascenzo, Fabrizio, Franke, Jennifer, Noutsias, Michel, Knorr, Maike, Heiner, Susanne, Burgdorf, Christof, Koenig, Wolfgang, Thiele, Holger, Tschope, Carsten, Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Karakas, Mahir, Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Dworakowski, Rafal, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Dichtl, Wolfgang, Delmas, Clement, Lairez, Olivier, Horowitz, John D., Kozel, Martin, Widimsky, Petr, Tousek, Petr, Winchester, David E., Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, El-Battrawy, Ibrahim, Akin, Ibrahim, Ukena, Christian, Bauersachs, Johann, Pieske, Burkert M., Hasenfuss, Gerd, Rottbauer, Wolfgang, Braun-Dullaeus, Ruediger C., Opolski, Grzegorz, MacCarthy, Philip, Felix, Stephan B., Borggrefe, Martin, Di Mario, Carlo, Crea, Filippo, Katus, Hugo A., Schunkert, Heribert, Munzel, Thomas, Bohm, Michael, Bax, Jeroen J., Prasad, Abhiram, Shinbane, Jerold, Luscher, Thomas F., Ruschitzka, Frank, Ghadri, Jelena R., Templin, Christian, Cammann, Victoria L., Sarcon, Annahita, Ding, Katharina J., Seifert, Burkhardt, Kato, Ken, Di Vece, Davide, Szawan, Konrad A., Gili, Sebastiano, Jurisic, Stjepan, Bacchi, Beatrice, Micek, Jozef, Frangieh, Antonio H., Napp, L. Christian, Jaguszewski, Milosz, Bossone, Eduardo, Citro, Rodolfo, D'Ascenzo, Fabrizio, Franke, Jennifer, Noutsias, Michel, Knorr, Maike, Heiner, Susanne, Burgdorf, Christof, Koenig, Wolfgang, Thiele, Holger, Tschope, Carsten, Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Karakas, Mahir, Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Dworakowski, Rafal, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Dichtl, Wolfgang, Delmas, Clement, Lairez, Olivier, Horowitz, John D., Kozel, Martin, Widimsky, Petr, Tousek, Petr, Winchester, David E., Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, El-Battrawy, Ibrahim, Akin, Ibrahim, Ukena, Christian, Bauersachs, Johann, Pieske, Burkert M., Hasenfuss, Gerd, Rottbauer, Wolfgang, Braun-Dullaeus, Ruediger C., Opolski, Grzegorz, MacCarthy, Philip, Felix, Stephan B., Borggrefe, Martin, Di Mario, Carlo, Crea, Filippo, Katus, Hugo A., Schunkert, Heribert, Munzel, Thomas, Bohm, Michael, Bax, Jeroen J., Prasad, Abhiram, Shinbane, Jerold, Luscher, Thomas F., Ruschitzka, Frank, Ghadri, Jelena R., and Templin, Christian
Abstract: Background-Clinical characteristics and outcomes of takotsubo syndrome (US) 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-ITS 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<0.001), while short-term outcome was comparable (P=0.17). In a subanalysis, long-term mortality was comparable between TTS patients with malignancies and ACS patients with malignancies (P=0.13). Malignancy emerged as an independent predictor of long-term mortality. Conclusions-A substantial number of TTS patients show an association with malignancy. History of malignancy might increase the risk for TTS, and therefore, appropriate screening for malignancy should be considered in these patients.
Published: 2019

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

Author: Gili, Sebastiano, Cammann, Victoria L., Schlossbauer, Susanne A., Kato, Ken, D'Ascenzo, Fabrizio, Di Vece, Davide, Jurisic, Stjepan, Micek, Jozef, Obeid, Slayman, Bacchi, Beatrice, Szawan, Konrad A., Famos, Flurina, Sarcon, Annahita, Levinson, Rena, Ding, Katharina J., Seifert, Burkhardt, Lenoir, Olivia, Bossone, Eduardo, Citro, Rodolfo, Franke, Jennifer, Napp, L. Christian, Jaguszewski, Milosz, Noutsias, Michel, Muenzel, Thomas, Knorr, Maike, Heiner, Susanne, Katus, Hugo A., Burgdorf, Christof, Schunkert, Heribert, Thiele, Holger, Bauersachs, Johann, Tschoepe, Carsten, Pieske, Burkert M., Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Hasenfuss, Gerd, Karakas, Mahir, Koenig, Wolfgang, Rottbauer, Wolfgang, Said, Samir M., Braun-Dullaeus, Ruediger C., Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Opolski, Grzegorz, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Crea, Filippo, Dichtl, Wolfgang, Empen, Klaus, Felix, Stephan B., Delmas, Clement, Lairez, Olivier, El-Battrawy, Ibrahim, Akin, Ibrahim, Borggrefe, Martin, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Horowitz, John D., Kozel, Martin, Tousek, Petr, Widimsky, Petr, Winchester, David E., Ukena, Christian, Gaita, Fiorenzo, Di Mario, Carlo, Wischnewsky, Manfred B., Bax, Jeroen J., Prasad, Abhiram, Boehm, Michael, Ruschitzka, Frank, Luescher, Thomas F., Ghadri, Jelena R., Templin, Christian, Gili, Sebastiano, Cammann, Victoria L., Schlossbauer, Susanne A., Kato, Ken, D'Ascenzo, Fabrizio, Di Vece, Davide, Jurisic, Stjepan, Micek, Jozef, Obeid, Slayman, Bacchi, Beatrice, Szawan, Konrad A., Famos, Flurina, Sarcon, Annahita, Levinson, Rena, Ding, Katharina J., Seifert, Burkhardt, Lenoir, Olivia, Bossone, Eduardo, Citro, Rodolfo, Franke, Jennifer, Napp, L. Christian, Jaguszewski, Milosz, Noutsias, Michel, Muenzel, Thomas, Knorr, Maike, Heiner, Susanne, Katus, Hugo A., Burgdorf, Christof, Schunkert, Heribert, Thiele, Holger, Bauersachs, Johann, Tschoepe, Carsten, Pieske, Burkert M., Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Hasenfuss, Gerd, Karakas, Mahir, Koenig, Wolfgang, Rottbauer, Wolfgang, Said, Samir M., Braun-Dullaeus, Ruediger C., Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Opolski, Grzegorz, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Crea, Filippo, Dichtl, Wolfgang, Empen, Klaus, Felix, Stephan B., Delmas, Clement, Lairez, Olivier, El-Battrawy, Ibrahim, Akin, Ibrahim, Borggrefe, Martin, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Horowitz, John D., Kozel, Martin, Tousek, Petr, Widimsky, Petr, Winchester, David E., Ukena, Christian, Gaita, Fiorenzo, Di Mario, Carlo, Wischnewsky, Manfred B., Bax, Jeroen J., Prasad, Abhiram, Boehm, Michael, Ruschitzka, Frank, Luescher, Thomas F., Ghadri, Jelena R., and Templin, Christian
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 < 0.001) and 5-year mortality (68.9% vs. 16.7%, P < 0.001) than patients without CA. T-wave inversion and intracranial haemorrhage were independently associated with higher 60-day mortality after CA, whereas female gender was associated with lower 60-day mortality. In the acute phase, CA occurred less frequently in females and more frequently in patients with AF, ST-segment elevation, and higher C-reactive protein on admission. 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

17. Clinical Predictors and Prognostic Impact of Recovery of Wall Motion Abnormalities in Takotsubo Syndrome: Results From the International Takotsubo Registry

Author: Jurisic, Stjepan, Gili, Sebastiano, Cammann, Victoria L., Kato, Ken, Szawan, Konrad A., D'Ascenzo, Fabrizio, Jaguszewski, Milosz, Bossone, Eduardo, Citro, Rodolfo, Sarcon, Annahita, Napp, L. Christian, Franke, Jennifer, Noutsias, Michel, Knorr, Maike, Heiner, Susanne, Burgdorf, Christof, Koenig, Wolfgang, Pott, Alexander, Kherad, Behrouz, Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Karakas, Mahir, Meyer, Philippe, Arroja, Jose David, Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Dworakowski, Rafal, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Dichtl, Wolfgang, Chan, Christina, Bridgman, Paul, Beug, Daniel, Delmas, Clement, Lairez, Olivier, Kozel, Martin, Tousek, Petr, Winchester, David E., Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, El-Battrawy, Ibrahim, Akin, Ibrahim, Galuszka, Jan, Ukena, Christian, Poglajen, Gregor, Paolini, Carla, Bilato, Claudio, Carrilho-Ferreira, Pedro, Pinto, Fausto J., Opolski, Grzegorz, MacCarthy, Philip, Kobayashi, Yoshio, Prasad, Abhiram, Rihal, Charanjit S., Widimsky, Petr, Horowitz, John D., Di Mario, Carlo, Crea, Filippo, Tschope, Carsten, Pieske, Burkert M., Hasenfuss, Gerd, Rottbauer, Wolfgang, Braun-Dullaeus, Ruediger C., Felix, Stephan B., Borggrefe, Martin, Thiele, Holger, Bauersachs, Johann, Katus, Hugo A., Schunkert, Heribert, Muenzel, Thomas, Bohm, Michael, Bax, Jeroen J., Luscher, Thomas F., Ruschitzka, Frank, Ghadri, Jelena R., Templin, Christian, Jurisic, Stjepan, Gili, Sebastiano, Cammann, Victoria L., Kato, Ken, Szawan, Konrad A., D'Ascenzo, Fabrizio, Jaguszewski, Milosz, Bossone, Eduardo, Citro, Rodolfo, Sarcon, Annahita, Napp, L. Christian, Franke, Jennifer, Noutsias, Michel, Knorr, Maike, Heiner, Susanne, Burgdorf, Christof, Koenig, Wolfgang, Pott, Alexander, Kherad, Behrouz, Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Karakas, Mahir, Meyer, Philippe, Arroja, Jose David, Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Dworakowski, Rafal, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Dichtl, Wolfgang, Chan, Christina, Bridgman, Paul, Beug, Daniel, Delmas, Clement, Lairez, Olivier, Kozel, Martin, Tousek, Petr, Winchester, David E., Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, El-Battrawy, Ibrahim, Akin, Ibrahim, Galuszka, Jan, Ukena, Christian, Poglajen, Gregor, Paolini, Carla, Bilato, Claudio, Carrilho-Ferreira, Pedro, Pinto, Fausto J., Opolski, Grzegorz, MacCarthy, Philip, Kobayashi, Yoshio, Prasad, Abhiram, Rihal, Charanjit S., Widimsky, Petr, Horowitz, John D., Di Mario, Carlo, Crea, Filippo, Tschope, Carsten, Pieske, Burkert M., Hasenfuss, Gerd, Rottbauer, Wolfgang, Braun-Dullaeus, Ruediger C., Felix, Stephan B., Borggrefe, Martin, Thiele, Holger, Bauersachs, Johann, Katus, Hugo A., Schunkert, Heribert, Muenzel, Thomas, Bohm, Michael, Bax, Jeroen J., Luscher, Thomas F., Ruschitzka, Frank, Ghadri, Jelena R., and Templin, Christian
Abstract: Background-Left ventricular (LV) recovery in takotsubo syndrome (TTS) occurs over a wide-ranging interval, varying from hours to weeks. We sought to investigate the clinical predictors and prognostic impact of recovery time for TTS patients. Methods and Results-TTS patients from the International Takotsubo Registry were included in this study. Cut-off for early LV recovery was determined to be 10 days after the acute event. Multivariable logistic regression was used to assess factors associated with the absence of early recovery. In-hospital outcomes and 1-year mortality were compared for patients with versus without early recovery. We analyzed 406 patients with comprehensive and serial imaging data regarding time to recovery. Of these, 191 (47.0%) had early LV recovery and 215 (53.0%) demonstrated late LV improvement. Patients without early recovery were more often male (12.6% versus 5.2%; P=0.011) and presented more frequently with typical TTS (76.3% versus 67.0%, P=0.040). Cardiac and inflammatory markers were higher in patients without early recovery than in those with early recovery. Patients without early recovery showed unfavorable 1-year outcome compared with patients with early recovery (P=0.003). On multiple logistic regression, male sex, LV ejection fraction <45%, and acute neurologic disorders were associated with the absence of early recovery. Conclusions-TTS patients without early LV recovery have different clinical characteristics and less favorable 1-year outcome compared with patients with early recovery. The factors associated with the absence of early recovery included male sex, reduced LV ejection fraction, and acute neurologic events.
Published: 2019

18. Clinical Predictors and Prognostic Impact of Recovery of Wall Motion Abnormalities in Takotsubo Syndrome: Results From the International Takotsubo Registry

Author: Jurisic, Stjepan, Gili, Sebastiano, Cammann, Victoria L, Kato, Ken, Szawan, Konrad A, et al, Ruschitzka, Frank; https://orcid.org/0000-0001-5972-0596, Ghadri, Jelena R, Templin, Christian; https://orcid.org/0000-0003-0287-4193, Lüscher, Thomas F; https://orcid.org/0000-0002-5259-538X, Jurisic, Stjepan, Gili, Sebastiano, Cammann, Victoria L, Kato, Ken, Szawan, Konrad A, et al, Ruschitzka, Frank; https://orcid.org/0000-0001-5972-0596, Ghadri, Jelena R, Templin, Christian; https://orcid.org/0000-0003-0287-4193, and Lüscher, Thomas F; https://orcid.org/0000-0002-5259-538X
Abstract: Background Left ventricular (LV) recovery in takotsubo syndrome (TTS) occurs over a wide-ranging interval, varying from hours to weeks. We sought to investigate the clinical predictors and prognostic impact of recovery time for TTS patients. Methods and Results TTS patients from the International Takotsubo Registry were included in this study. Cut-off for early LV recovery was determined to be 10 days after the acute event. Multivariable logistic regression was used to assess factors associated with the absence of early recovery. In-hospital outcomes and 1-year mortality were compared for patients with versus without early recovery. We analyzed 406 patients with comprehensive and serial imaging data regarding time to recovery. Of these, 191 (47.0%) had early LV recovery and 215 (53.0%) demonstrated late LV improvement. Patients without early recovery were more often male (12.6% versus 5.2%; P=0.011) and presented more frequently with typical TTS (76.3% versus 67.0%, P=0.040). Cardiac and inflammatory markers were higher in patients without early recovery than in those with early recovery. Patients without early recovery showed unfavorable 1-year outcome compared with patients with early recovery (P=0.003). On multiple logistic regression, male sex, LV ejection fraction <45%, and acute neurologic disorders were associated with the absence of early recovery. Conclusions TTS patients without early LV recovery have different clinical characteristics and less favorable 1-year outcome compared with patients with early recovery. The factors associated with the absence of early recovery included male sex, reduced LV ejection fraction, and acute neurologic events. Clinical Trial Registration URL: http://www.clinicaltrials.gov. Unique identifier: NCT01947621.
Published: 2019

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

Author: Cammann, Victoria Lucia, Sarcon, Annahita, Ding, Katharina J, Seifert, Burkhardt, Kato, Ken, Di Vece, Davide, Szawan, Konrad A, Gili, Sebastiano, Jurisic, Stjepan, Bacchi, Beatrice, Micek, Jozef, Frangieh, Antonio H, Napp, L Christian, Lüscher, Thomas F; https://orcid.org/0000-0002-5259-538X, Ruschitzka, Frank; https://orcid.org/0000-0001-5972-0596, Ghadri, Jelena R, Templin, Christian; https://orcid.org/0000-0003-0287-4193, et al, Cammann, Victoria Lucia, Sarcon, Annahita, Ding, Katharina J, Seifert, Burkhardt, Kato, Ken, Di Vece, Davide, Szawan, Konrad A, Gili, Sebastiano, Jurisic, Stjepan, Bacchi, Beatrice, Micek, Jozef, Frangieh, Antonio H, Napp, L Christian, Lüscher, Thomas F; https://orcid.org/0000-0002-5259-538X, Ruschitzka, Frank; https://orcid.org/0000-0001-5972-0596, Ghadri, Jelena R, Templin, Christian; https://orcid.org/0000-0003-0287-4193, and et al
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<0.001), while short-term outcome was comparable (P=0.17). In a subanalysis, long-term mortality was comparable between TTS patients with malignancies and ACS patients with malignancies (P=0.13). Malignancy emerged as an independent predictor of long-term mortality. Conclusions A substantial number of TTS patients show an association with malignancy. History of malignancy might increase the risk for TTS, and therefore, appropriate screening for malignancy should be considered in these patients. Clinical Trial Registration URL: http://www.clinicaltrial.gov. Unique identifier: NCT01947621.
Published: 2019

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

Author: Gili, Sebastiano, Cammann, Victoria L, Schlossbauer, Susanne A, Kato, Ken, D'Ascenzo, Fabrizio, Di Vece, Davide, Jurisic, Stjepan, Micek, Jozef, Obeid, Slayman, Bacchi, Beatrice, Szawan, Konrad A, Famos, Flurina, Sarcon, Annahita, Levinson, Rena, Ding, Katharina J, Seifert, Burkhardt, Lenoir, Olivia, Bossone, Eduardo, Citro, Rodolfo, Franke, Jennifer, Napp, L Christian, Jaguszewski, Milosz, Noutsias, Michel, Münzel, Thomas, Knorr, Maike, Heiner, Susanne, Katus, Hugo A, Burgdorf, Christof, Schunkert, Heribert, Thiele, Holger, et al, Gili, Sebastiano, Cammann, Victoria L, Schlossbauer, Susanne A, Kato, Ken, D'Ascenzo, Fabrizio, Di Vece, Davide, Jurisic, Stjepan, Micek, Jozef, Obeid, Slayman, Bacchi, Beatrice, Szawan, Konrad A, Famos, Flurina, Sarcon, Annahita, Levinson, Rena, Ding, Katharina J, Seifert, Burkhardt, Lenoir, Olivia, Bossone, Eduardo, Citro, Rodolfo, Franke, Jennifer, Napp, L Christian, Jaguszewski, Milosz, Noutsias, Michel, Münzel, Thomas, Knorr, Maike, Heiner, Susanne, Katus, Hugo A, Burgdorf, Christof, Schunkert, Heribert, Thiele, Holger, and et al
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 < 0.001) and 5-year mortality (68.9% vs. 16.7%, P < 0.001) than patients without CA. T-wave inversion and intracranial haemorrhage were independently associated with higher 60-day mortality after CA, whereas female gender was associated with lower 60-day mortality. In the acute phase, CA occurred less frequently in females and more frequently in patients with AF, ST-segment elevation, and higher C-reactive protein on admission. 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

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

Author: Cammann, Victoria L., Sarcon, Annahita, Ding, Katharina J., Seifert, Burkhardt, Kato, Ken, Di Vece, Davide, Szawan, Konrad A., Gili, Sebastiano, Jurisic, Stjepan, Bacchi, Beatrice, Micek, Jozef, Frangieh, Antonio H., Napp, L. Christian, Jaguszewski, Milosz, Bossone, Eduardo, Citro, Rodolfo, D'Ascenzo, Fabrizio, Franke, Jennifer, Noutsias, Michel, Knorr, Maike, Heiner, Susanne, Burgdorf, Christof, Koenig, Wolfgang, Thiele, Holger, Tschope, Carsten, Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Karakas, Mahir, Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Dworakowski, Rafal, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Dichtl, Wolfgang, Delmas, Clement, Lairez, Olivier, Horowitz, John D., Kozel, Martin, Widimsky, Petr, Tousek, Petr, Winchester, David E., Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, El-Battrawy, Ibrahim, Akin, Ibrahim, Ukena, Christian, Bauersachs, Johann, Pieske, Burkert M., Hasenfuss, Gerd, Rottbauer, Wolfgang, Braun-Dullaeus, Ruediger C., Opolski, Grzegorz, MacCarthy, Philip, Felix, Stephan B., Borggrefe, Martin, Di Mario, Carlo, Crea, Filippo, Katus, Hugo A., Schunkert, Heribert, Munzel, Thomas, Bohm, Michael, Bax, Jeroen J., Prasad, Abhiram, Shinbane, Jerold, Luscher, Thomas F., Ruschitzka, Frank, Ghadri, Jelena R., Templin, Christian, Cammann, Victoria L., Sarcon, Annahita, Ding, Katharina J., Seifert, Burkhardt, Kato, Ken, Di Vece, Davide, Szawan, Konrad A., Gili, Sebastiano, Jurisic, Stjepan, Bacchi, Beatrice, Micek, Jozef, Frangieh, Antonio H., Napp, L. Christian, Jaguszewski, Milosz, Bossone, Eduardo, Citro, Rodolfo, D'Ascenzo, Fabrizio, Franke, Jennifer, Noutsias, Michel, Knorr, Maike, Heiner, Susanne, Burgdorf, Christof, Koenig, Wolfgang, Thiele, Holger, Tschope, Carsten, Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Karakas, Mahir, Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Dworakowski, Rafal, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Dichtl, Wolfgang, Delmas, Clement, Lairez, Olivier, Horowitz, John D., Kozel, Martin, Widimsky, Petr, Tousek, Petr, Winchester, David E., Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, El-Battrawy, Ibrahim, Akin, Ibrahim, Ukena, Christian, Bauersachs, Johann, Pieske, Burkert M., Hasenfuss, Gerd, Rottbauer, Wolfgang, Braun-Dullaeus, Ruediger C., Opolski, Grzegorz, MacCarthy, Philip, Felix, Stephan B., Borggrefe, Martin, Di Mario, Carlo, Crea, Filippo, Katus, Hugo A., Schunkert, Heribert, Munzel, Thomas, Bohm, Michael, Bax, Jeroen J., Prasad, Abhiram, Shinbane, Jerold, Luscher, Thomas F., Ruschitzka, Frank, Ghadri, Jelena R., and Templin, Christian
Abstract: Background-Clinical characteristics and outcomes of takotsubo syndrome (US) 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-ITS 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<0.001), while short-term outcome was comparable (P=0.17). In a subanalysis, long-term mortality was comparable between TTS patients with malignancies and ACS patients with malignancies (P=0.13). Malignancy emerged as an independent predictor of long-term mortality. Conclusions-A substantial number of TTS patients show an association with malignancy. History of malignancy might increase the risk for TTS, and therefore, appropriate screening for malignancy should be considered in these patients.
Published: 2019

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

Author: Gili, Sebastiano, Cammann, Victoria L., Schlossbauer, Susanne A., Kato, Ken, D'Ascenzo, Fabrizio, Di Vece, Davide, Jurisic, Stjepan, Micek, Jozef, Obeid, Slayman, Bacchi, Beatrice, Szawan, Konrad A., Famos, Flurina, Sarcon, Annahita, Levinson, Rena, Ding, Katharina J., Seifert, Burkhardt, Lenoir, Olivia, Bossone, Eduardo, Citro, Rodolfo, Franke, Jennifer, Napp, L. Christian, Jaguszewski, Milosz, Noutsias, Michel, Muenzel, Thomas, Knorr, Maike, Heiner, Susanne, Katus, Hugo A., Burgdorf, Christof, Schunkert, Heribert, Thiele, Holger, Bauersachs, Johann, Tschoepe, Carsten, Pieske, Burkert M., Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Hasenfuss, Gerd, Karakas, Mahir, Koenig, Wolfgang, Rottbauer, Wolfgang, Said, Samir M., Braun-Dullaeus, Ruediger C., Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Opolski, Grzegorz, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Crea, Filippo, Dichtl, Wolfgang, Empen, Klaus, Felix, Stephan B., Delmas, Clement, Lairez, Olivier, El-Battrawy, Ibrahim, Akin, Ibrahim, Borggrefe, Martin, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Horowitz, John D., Kozel, Martin, Tousek, Petr, Widimsky, Petr, Winchester, David E., Ukena, Christian, Gaita, Fiorenzo, Di Mario, Carlo, Wischnewsky, Manfred B., Bax, Jeroen J., Prasad, Abhiram, Boehm, Michael, Ruschitzka, Frank, Luescher, Thomas F., Ghadri, Jelena R., Templin, Christian, Gili, Sebastiano, Cammann, Victoria L., Schlossbauer, Susanne A., Kato, Ken, D'Ascenzo, Fabrizio, Di Vece, Davide, Jurisic, Stjepan, Micek, Jozef, Obeid, Slayman, Bacchi, Beatrice, Szawan, Konrad A., Famos, Flurina, Sarcon, Annahita, Levinson, Rena, Ding, Katharina J., Seifert, Burkhardt, Lenoir, Olivia, Bossone, Eduardo, Citro, Rodolfo, Franke, Jennifer, Napp, L. Christian, Jaguszewski, Milosz, Noutsias, Michel, Muenzel, Thomas, Knorr, Maike, Heiner, Susanne, Katus, Hugo A., Burgdorf, Christof, Schunkert, Heribert, Thiele, Holger, Bauersachs, Johann, Tschoepe, Carsten, Pieske, Burkert M., Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Hasenfuss, Gerd, Karakas, Mahir, Koenig, Wolfgang, Rottbauer, Wolfgang, Said, Samir M., Braun-Dullaeus, Ruediger C., Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Opolski, Grzegorz, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Crea, Filippo, Dichtl, Wolfgang, Empen, Klaus, Felix, Stephan B., Delmas, Clement, Lairez, Olivier, El-Battrawy, Ibrahim, Akin, Ibrahim, Borggrefe, Martin, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Horowitz, John D., Kozel, Martin, Tousek, Petr, Widimsky, Petr, Winchester, David E., Ukena, Christian, Gaita, Fiorenzo, Di Mario, Carlo, Wischnewsky, Manfred B., Bax, Jeroen J., Prasad, Abhiram, Boehm, Michael, Ruschitzka, Frank, Luescher, Thomas F., Ghadri, Jelena R., and Templin, Christian
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 < 0.001) and 5-year mortality (68.9% vs. 16.7%, P < 0.001) than patients without CA. T-wave inversion and intracranial haemorrhage were independently associated with higher 60-day mortality after CA, whereas female gender was associated with lower 60-day mortality. In the acute phase, CA occurred less frequently in females and more frequently in patients with AF, ST-segment elevation, and higher C-reactive protein on admission. 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

23. Clinical Predictors and Prognostic Impact of Recovery of Wall Motion Abnormalities in Takotsubo Syndrome: Results From the International Takotsubo Registry

Author: Jurisic, Stjepan, Gili, Sebastiano, Cammann, Victoria L., Kato, Ken, Szawan, Konrad A., D'Ascenzo, Fabrizio, Jaguszewski, Milosz, Bossone, Eduardo, Citro, Rodolfo, Sarcon, Annahita, Napp, L. Christian, Franke, Jennifer, Noutsias, Michel, Knorr, Maike, Heiner, Susanne, Burgdorf, Christof, Koenig, Wolfgang, Pott, Alexander, Kherad, Behrouz, Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Karakas, Mahir, Meyer, Philippe, Arroja, Jose David, Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Dworakowski, Rafal, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Dichtl, Wolfgang, Chan, Christina, Bridgman, Paul, Beug, Daniel, Delmas, Clement, Lairez, Olivier, Kozel, Martin, Tousek, Petr, Winchester, David E., Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, El-Battrawy, Ibrahim, Akin, Ibrahim, Galuszka, Jan, Ukena, Christian, Poglajen, Gregor, Paolini, Carla, Bilato, Claudio, Carrilho-Ferreira, Pedro, Pinto, Fausto J., Opolski, Grzegorz, MacCarthy, Philip, Kobayashi, Yoshio, Prasad, Abhiram, Rihal, Charanjit S., Widimsky, Petr, Horowitz, John D., Di Mario, Carlo, Crea, Filippo, Tschope, Carsten, Pieske, Burkert M., Hasenfuss, Gerd, Rottbauer, Wolfgang, Braun-Dullaeus, Ruediger C., Felix, Stephan B., Borggrefe, Martin, Thiele, Holger, Bauersachs, Johann, Katus, Hugo A., Schunkert, Heribert, Muenzel, Thomas, Bohm, Michael, Bax, Jeroen J., Luscher, Thomas F., Ruschitzka, Frank, Ghadri, Jelena R., Templin, Christian, Jurisic, Stjepan, Gili, Sebastiano, Cammann, Victoria L., Kato, Ken, Szawan, Konrad A., D'Ascenzo, Fabrizio, Jaguszewski, Milosz, Bossone, Eduardo, Citro, Rodolfo, Sarcon, Annahita, Napp, L. Christian, Franke, Jennifer, Noutsias, Michel, Knorr, Maike, Heiner, Susanne, Burgdorf, Christof, Koenig, Wolfgang, Pott, Alexander, Kherad, Behrouz, Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Karakas, Mahir, Meyer, Philippe, Arroja, Jose David, Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Dworakowski, Rafal, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Dichtl, Wolfgang, Chan, Christina, Bridgman, Paul, Beug, Daniel, Delmas, Clement, Lairez, Olivier, Kozel, Martin, Tousek, Petr, Winchester, David E., Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, El-Battrawy, Ibrahim, Akin, Ibrahim, Galuszka, Jan, Ukena, Christian, Poglajen, Gregor, Paolini, Carla, Bilato, Claudio, Carrilho-Ferreira, Pedro, Pinto, Fausto J., Opolski, Grzegorz, MacCarthy, Philip, Kobayashi, Yoshio, Prasad, Abhiram, Rihal, Charanjit S., Widimsky, Petr, Horowitz, John D., Di Mario, Carlo, Crea, Filippo, Tschope, Carsten, Pieske, Burkert M., Hasenfuss, Gerd, Rottbauer, Wolfgang, Braun-Dullaeus, Ruediger C., Felix, Stephan B., Borggrefe, Martin, Thiele, Holger, Bauersachs, Johann, Katus, Hugo A., Schunkert, Heribert, Muenzel, Thomas, Bohm, Michael, Bax, Jeroen J., Luscher, Thomas F., Ruschitzka, Frank, Ghadri, Jelena R., and Templin, Christian
Abstract: Background-Left ventricular (LV) recovery in takotsubo syndrome (TTS) occurs over a wide-ranging interval, varying from hours to weeks. We sought to investigate the clinical predictors and prognostic impact of recovery time for TTS patients. Methods and Results-TTS patients from the International Takotsubo Registry were included in this study. Cut-off for early LV recovery was determined to be 10 days after the acute event. Multivariable logistic regression was used to assess factors associated with the absence of early recovery. In-hospital outcomes and 1-year mortality were compared for patients with versus without early recovery. We analyzed 406 patients with comprehensive and serial imaging data regarding time to recovery. Of these, 191 (47.0%) had early LV recovery and 215 (53.0%) demonstrated late LV improvement. Patients without early recovery were more often male (12.6% versus 5.2%; P=0.011) and presented more frequently with typical TTS (76.3% versus 67.0%, P=0.040). Cardiac and inflammatory markers were higher in patients without early recovery than in those with early recovery. Patients without early recovery showed unfavorable 1-year outcome compared with patients with early recovery (P=0.003). On multiple logistic regression, male sex, LV ejection fraction <45%, and acute neurologic disorders were associated with the absence of early recovery. Conclusions-TTS patients without early LV recovery have different clinical characteristics and less favorable 1-year outcome compared with patients with early recovery. The factors associated with the absence of early recovery included male sex, reduced LV ejection fraction, and acute neurologic events.
Published: 2019

24. European position paper on the management of patients with patent foramen ovale:General approach and left circulation thromboembolism

Author: Pristipino, Christian, Sievert, Horst, D'Ascenzo, Fabrizio, Louis Mas, Jean, Meier, Bernhard, Scacciatella, Paolo, Hildick-Smith, David, Gaita, Fiorenzo, Toni, Danilo, Kyrle, Paul, Thomson, John, Derumeaux, Genevieve, Onorato, Eustaquio, Sibbing, Dirk, Germonpré, Peter, Berti, Sergio, Chessa, Massimo, Bedogni, Francesco, Dudek, Dariusz, Hornung, Marius, Zamorano, Jose, Omedè, Pierluigi, Ballocca, Flavia, Barbero, Umberto, Giordana, Francesca, Gili, Sebastiano, Iannaccone, Mario, Capodannno, Davide, Valgimigli, Marco, Byrne, Robert, Akagi, Teiji, Carroll, John, Dalvi, Bharat, Ge, Junbo, Kasner, Scott, Michel-Behnke, Ina, Pedra, Carlos, Rhodes, John, Søndergaard, Lars, Thomassen, Lars, Biondi-Zoccai, Giuseppe G.L., Pristipino, Christian, Sievert, Horst, D'Ascenzo, Fabrizio, Louis Mas, Jean, Meier, Bernhard, Scacciatella, Paolo, Hildick-Smith, David, Gaita, Fiorenzo, Toni, Danilo, Kyrle, Paul, Thomson, John, Derumeaux, Genevieve, Onorato, Eustaquio, Sibbing, Dirk, Germonpré, Peter, Berti, Sergio, Chessa, Massimo, Bedogni, Francesco, Dudek, Dariusz, Hornung, Marius, Zamorano, Jose, Omedè, Pierluigi, Ballocca, Flavia, Barbero, Umberto, Giordana, Francesca, Gili, Sebastiano, Iannaccone, Mario, Capodannno, Davide, Valgimigli, Marco, Byrne, Robert, Akagi, Teiji, Carroll, John, Dalvi, Bharat, Ge, Junbo, Kasner, Scott, Michel-Behnke, Ina, Pedra, Carlos, Rhodes, John, Søndergaard, Lars, Thomassen, Lars, and Biondi-Zoccai, Giuseppe G.L.
Abstract: The presence of a patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions; however, the subject remains controversial and no official statements have been published. This interdisciplinary paper, prepared with involvement of eight European scientific societies, aims to review the available trial evidence and to define the principles needed to guide decision making in patients with PFO. In order to guarantee a strict process, position statements were developed with the use of a modified grading of recommendations assessment, development, and evaluation (GRADE) methodology. A critical qualitative and quantitative evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk/benefit ratio. The level of evidence and the strength of the position statements of particular management options were weighed and graded according to predefined scales. Despite being based often on limited and non-randomised data, while waiting for more conclusive evidence, it was possible to conclude on a number of position statements regarding a rational general approach to PFO management and to specific considerations regarding left circulation thromboembolism. For some therapeutic aspects, it was possible to express stricter position statements based on randomised trials. This position paper provides the first largely shared, interdisciplinary approach for a rational PFO management based on the best available evidence.
Published: 2019

25. European position paper on the management of patients with patent foramen ovale:General approach and left circulation thromboembolism

Author: Pristipino, Christian, Sievert, Horst, D'Ascenzo, Fabrizio, Louis Mas, Jean, Meier, Bernhard, Scacciatella, Paolo, Hildick-Smith, David, Gaita, Fiorenzo, Toni, Danilo, Kyrle, Paul, Thomson, John, Derumeaux, Genevieve, Onorato, Eustaquio, Sibbing, Dirk, Germonpré, Peter, Berti, Sergio, Chessa, Massimo, Bedogni, Francesco, Dudek, Dariusz, Hornung, Marius, Zamorano, Jose, Omedè, Pierluigi, Ballocca, Flavia, Barbero, Umberto, Giordana, Francesca, Gili, Sebastiano, Iannaccone, Mario, Capodannno, Davide, Valgimigli, Marco, Byrne, Robert, Akagi, Teiji, Carroll, John, Dalvi, Bharat, Ge, Junbo, Kasner, Scott, Michel-Behnke, Ina, Pedra, Carlos, Rhodes, John, Søndergaard, Lars, Thomassen, Lars, Biondi-Zoccai, Giuseppe G.L., Pristipino, Christian, Sievert, Horst, D'Ascenzo, Fabrizio, Louis Mas, Jean, Meier, Bernhard, Scacciatella, Paolo, Hildick-Smith, David, Gaita, Fiorenzo, Toni, Danilo, Kyrle, Paul, Thomson, John, Derumeaux, Genevieve, Onorato, Eustaquio, Sibbing, Dirk, Germonpré, Peter, Berti, Sergio, Chessa, Massimo, Bedogni, Francesco, Dudek, Dariusz, Hornung, Marius, Zamorano, Jose, Omedè, Pierluigi, Ballocca, Flavia, Barbero, Umberto, Giordana, Francesca, Gili, Sebastiano, Iannaccone, Mario, Capodannno, Davide, Valgimigli, Marco, Byrne, Robert, Akagi, Teiji, Carroll, John, Dalvi, Bharat, Ge, Junbo, Kasner, Scott, Michel-Behnke, Ina, Pedra, Carlos, Rhodes, John, Søndergaard, Lars, Thomassen, Lars, and Biondi-Zoccai, Giuseppe G.L.
Abstract: The presence of a patent foramen ovale (PFO) is implicated in the pathogenesis of a number of medical conditions; however, the subject remains controversial and no official statements have been published. This interdisciplinary paper, prepared with involvement of eight European scientific societies, aims to review the available trial evidence and to define the principles needed to guide decision making in patients with PFO. In order to guarantee a strict process, position statements were developed with the use of a modified grading of recommendations assessment, development, and evaluation (GRADE) methodology. A critical qualitative and quantitative evaluation of diagnostic and therapeutic procedures was performed, including assessment of the risk/benefit ratio. The level of evidence and the strength of the position statements of particular management options were weighed and graded according to predefined scales. Despite being based often on limited and non-randomised data, while waiting for more conclusive evidence, it was possible to conclude on a number of position statements regarding a rational general approach to PFO management and to specific considerations regarding left circulation thromboembolism. For some therapeutic aspects, it was possible to express stricter position statements based on randomised trials. This position paper provides the first largely shared, interdisciplinary approach for a rational PFO management based on the best available evidence.
Published: 2019

26. Long-Term Prognosis of Patients With Takotsubo Syndrome

Author: Ghadri, Jelena R., Kato, Ken, Cammann, Victoria L., Gili, Sebastiano, Jurisic, Stjepan, Di Vece, Davide, Candreva, Alessandro, Ding, Katharina J., Micek, Jozef, Szawan, Konrad A., Bacchi, Beatrice, Bianchi, Rahel, Levinson, Rena A., Wischnewsky, Manfred, Seifert, Burkhardt, Schlossbauer, Susanne A., Citro, Rodolfo, Bossone, Eduardo, Muenzel, Thomas, Knorr, Maike, Heiner, Susanne, D'Ascenzo, Fabrizio, Franke, Jennifer, Sarcon, Annahita, Napp, L. Christian, Jaguszewski, Milosz, Noutsias, Michel, Katus, Hugo A., Burgdorf, Christof, Schunkert, Heribert, Thiele, Holger, Bauersachs, Johann, Tschoepe, Carsten, Pieske, Burkert M., Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Hasenfuss, Gerd, Karakas, Mahir, Koenig, Wolfgang, Rottbauer, Wolfgang, Said, Samir M., Braun-Dullaeus, Ruediger C., Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Opolski, Grzegorz, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Crea, Filippo, Dichtl, Wolfgang, Empen, Klaus, Felix, Stephan B., Delmas, Clement, Lairez, Olivier, El-Battrawy, Ibrahim, Akin, Ibrahim, Borggrefe, Martin, Horowitz, John, Kozel, Martin, Tousek, Petr, Widimsky, Petr, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Winchester, David E., Ukena, Christian, Bax, Jeroen J., Prasad, Abhiram, Boehm, Michael, Luscher, Thomas F., Ruschitzka, Frank, Templin, Christian, Ghadri, Jelena R., Kato, Ken, Cammann, Victoria L., Gili, Sebastiano, Jurisic, Stjepan, Di Vece, Davide, Candreva, Alessandro, Ding, Katharina J., Micek, Jozef, Szawan, Konrad A., Bacchi, Beatrice, Bianchi, Rahel, Levinson, Rena A., Wischnewsky, Manfred, Seifert, Burkhardt, Schlossbauer, Susanne A., Citro, Rodolfo, Bossone, Eduardo, Muenzel, Thomas, Knorr, Maike, Heiner, Susanne, D'Ascenzo, Fabrizio, Franke, Jennifer, Sarcon, Annahita, Napp, L. Christian, Jaguszewski, Milosz, Noutsias, Michel, Katus, Hugo A., Burgdorf, Christof, Schunkert, Heribert, Thiele, Holger, Bauersachs, Johann, Tschoepe, Carsten, Pieske, Burkert M., Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Hasenfuss, Gerd, Karakas, Mahir, Koenig, Wolfgang, Rottbauer, Wolfgang, Said, Samir M., Braun-Dullaeus, Ruediger C., Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Opolski, Grzegorz, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Crea, Filippo, Dichtl, Wolfgang, Empen, Klaus, Felix, Stephan B., Delmas, Clement, Lairez, Olivier, El-Battrawy, Ibrahim, Akin, Ibrahim, Borggrefe, Martin, Horowitz, John, Kozel, Martin, Tousek, Petr, Widimsky, Petr, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Winchester, David E., Ukena, Christian, Bax, Jeroen J., Prasad, Abhiram, Boehm, Michael, Luscher, Thomas F., Ruschitzka, Frank, and Templin, Christian
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. (C) 2018 by the American College of Cardiology Foundation.
Published: 2018

27. Long-Term Prognosis of Patients With Takotsubo Syndrome

Author: Ghadri, Jelena R, Kato, Ken, Cammann, Victoria L, Gili, Sebastiano, Jurisic, Stjepan, Di Vece, Davide, Candreva, Alessandro, Ding, Katharina J, Micek, Jozef, Szawan, Konrad A, Bacchi, Beatrice, Bianchi, Rahel, Seifert, Burkhardt, Schlossbauer, Susanne A, et al, Ghadri, Jelena R, Kato, Ken, Cammann, Victoria L, Gili, Sebastiano, Jurisic, Stjepan, Di Vece, Davide, Candreva, Alessandro, Ding, Katharina J, Micek, Jozef, Szawan, Konrad A, Bacchi, Beatrice, Bianchi, Rahel, Seifert, Burkhardt, Schlossbauer, Susanne A, and et al
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

28. Long-Term Prognosis of Patients With Takotsubo Syndrome

Author: Ghadri, Jelena R., Kato, Ken, Cammann, Victoria L., Gili, Sebastiano, Jurisic, Stjepan, Di Vece, Davide, Candreva, Alessandro, Ding, Katharina J., Micek, Jozef, Szawan, Konrad A., Bacchi, Beatrice, Bianchi, Rahel, Levinson, Rena A., Wischnewsky, Manfred, Seifert, Burkhardt, Schlossbauer, Susanne A., Citro, Rodolfo, Bossone, Eduardo, Muenzel, Thomas, Knorr, Maike, Heiner, Susanne, D'Ascenzo, Fabrizio, Franke, Jennifer, Sarcon, Annahita, Napp, L. Christian, Jaguszewski, Milosz, Noutsias, Michel, Katus, Hugo A., Burgdorf, Christof, Schunkert, Heribert, Thiele, Holger, Bauersachs, Johann, Tschoepe, Carsten, Pieske, Burkert M., Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Hasenfuss, Gerd, Karakas, Mahir, Koenig, Wolfgang, Rottbauer, Wolfgang, Said, Samir M., Braun-Dullaeus, Ruediger C., Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Opolski, Grzegorz, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Crea, Filippo, Dichtl, Wolfgang, Empen, Klaus, Felix, Stephan B., Delmas, Clement, Lairez, Olivier, El-Battrawy, Ibrahim, Akin, Ibrahim, Borggrefe, Martin, Horowitz, John, Kozel, Martin, Tousek, Petr, Widimsky, Petr, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Winchester, David E., Ukena, Christian, Bax, Jeroen J., Prasad, Abhiram, Boehm, Michael, Luscher, Thomas F., Ruschitzka, Frank, Templin, Christian, Ghadri, Jelena R., Kato, Ken, Cammann, Victoria L., Gili, Sebastiano, Jurisic, Stjepan, Di Vece, Davide, Candreva, Alessandro, Ding, Katharina J., Micek, Jozef, Szawan, Konrad A., Bacchi, Beatrice, Bianchi, Rahel, Levinson, Rena A., Wischnewsky, Manfred, Seifert, Burkhardt, Schlossbauer, Susanne A., Citro, Rodolfo, Bossone, Eduardo, Muenzel, Thomas, Knorr, Maike, Heiner, Susanne, D'Ascenzo, Fabrizio, Franke, Jennifer, Sarcon, Annahita, Napp, L. Christian, Jaguszewski, Milosz, Noutsias, Michel, Katus, Hugo A., Burgdorf, Christof, Schunkert, Heribert, Thiele, Holger, Bauersachs, Johann, Tschoepe, Carsten, Pieske, Burkert M., Rajan, Lawrence, Michels, Guido, Pfister, Roman, Cuneo, Alessandro, Jacobshagen, Claudius, Hasenfuss, Gerd, Karakas, Mahir, Koenig, Wolfgang, Rottbauer, Wolfgang, Said, Samir M., Braun-Dullaeus, Ruediger C., Banning, Adrian, Cuculi, Florim, Kobza, Richard, Fischer, Thomas A., Vasankari, Tuija, Airaksinen, K. E. Juhani, Opolski, Grzegorz, Dworakowski, Rafal, MacCarthy, Philip, Kaiser, Christoph, Osswald, Stefan, Galiuto, Leonarda, Crea, Filippo, Dichtl, Wolfgang, Empen, Klaus, Felix, Stephan B., Delmas, Clement, Lairez, Olivier, El-Battrawy, Ibrahim, Akin, Ibrahim, Borggrefe, Martin, Horowitz, John, Kozel, Martin, Tousek, Petr, Widimsky, Petr, Gilyarova, Ekaterina, Shilova, Alexandra, Gilyarov, Mikhail, Winchester, David E., Ukena, Christian, Bax, Jeroen J., Prasad, Abhiram, Boehm, Michael, Luscher, Thomas F., Ruschitzka, Frank, and Templin, Christian
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. (C) 2018 by the American College of Cardiology Foundation.
Published: 2018

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28 results on '"Gili, Sebastiano"'

1. Machine learning-based prediction of in-hospital death for patients with takotsubo syndrome: The InterTAK-ML model

2. Ethnic comparison in takotsubo syndrome: novel insights from the International Takotsubo Registry

3. Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry

4. Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry

5. European position paper on the management of patients with patent foramen ovale:Part II - Decompression sickness, migraine, arterial deoxygenation syndromes and select high-risk clinical conditions

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

7. Prognostically relevant periprocedural myocardial injury and infarction associated with percutaneous coronary interventions: A Consensus Document of the ESC Working Group on Cellular Biology of the Heart and European Association of Percutaneous Cardiovascular Interventions (EAPCI)

8. Impact of Atrial Fibrillation on Outcome in Takotsubo Syndrome: Data From the International Takotsubo Registry

9. Impact of aspirin on takotsubo syndrome: a propensity score-based analysis of the InterTAK Registry

10. Age -Related Variations in Takotsubo Syndrome

11. Coexistence and outcome of coronary artery disease in Takotsubo syndrome

12. Impact of aspirin on takotsubo syndrome: a propensity score-based analysis of the InterTAK Registry

13. Age -Related Variations in Takotsubo Syndrome

14. Coexistence and outcome of coronary artery disease in Takotsubo syndrome

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

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

17. Clinical Predictors and Prognostic Impact of Recovery of Wall Motion Abnormalities in Takotsubo Syndrome: Results From the International Takotsubo Registry

18. Clinical Predictors and Prognostic Impact of Recovery of Wall Motion Abnormalities in Takotsubo Syndrome: Results From the International Takotsubo Registry

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

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

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

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

23. Clinical Predictors and Prognostic Impact of Recovery of Wall Motion Abnormalities in Takotsubo Syndrome: Results From the International Takotsubo Registry

24. European position paper on the management of patients with patent foramen ovale:General approach and left circulation thromboembolism

25. European position paper on the management of patients with patent foramen ovale:General approach and left circulation thromboembolism

26. Long-Term Prognosis of Patients With Takotsubo Syndrome

27. Long-Term Prognosis of Patients With Takotsubo Syndrome

28. Long-Term Prognosis of Patients With Takotsubo Syndrome

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28 results on '"Gili, Sebastiano"'

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