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Background Takotsubo Syndrome (TTS) is an acute reversible left ventricular dysfunction. Recently published studies have highlighted a similar mortality rate as acute coronary syndrome (ACS). We compared the impact of gender differences on the outcome of TTS patients as compared to ACS patient. Design and methods We included a collective of 138 patients TTS between 2003 and 2016 at our institution. Patients were divided according to their gender into two groups (Males n =21, 15% and females, n =117, 85%). They were compared with a cohort of 300 patients with a diagnosis of ACS. Results On the acute phase, in male patients with TTS, a treatment with inotropic was more often required (33.3 vs. 11.5%, P <0.01), were more susceptible to cardiogenic shock (28.6 vs. 12.5%, P <0.04). Concerning the long-term prognosis after the acute event, male patients had higher all-cause mortality over long-term follow-up. A Kaplan–Meier analysis indicated that the mortality of male patients with TTS was significantly higher compared to male patients with ACS (log-rank <0.01), while there was no significant difference between female patients with TTS and ACS (log-rank =0.60, P =0.45). In a multivariate cox regression analysis, male gender (HR 2.7, 95% CI: 1.1–6.5, P =0.02) GFR <60 ml/min (HR 2.8, 95% CI: 1.2–6.0, P =0.01) and history of cancer (HR 3.6, 95% CI 1.4–9.3, P <0.01) were independent predictors of 5-year mortality. Conclusions Considerable evidence suggests that TTS compared to ACS implicates more significant clinical short-term events on male patients and it may be associated with poorer long-term prognosis. [ABSTRACT FROM AUTHOR]

Aim: Takotsubo syndrome (TTS) patients have a higher mortality rate than the general population. Our study was conducted to determine the short- and long-term outcome of TTS patients associated with a significantly compromised mitral annular plane systolic excursion (MAPSE) on hospital admission. Methods and results: Our institutional database constituted a collective of 53 patients diagnosed with TTS between 2003 and 2016. The patients were classified into two groups based on the MAPSE, with those presenting with an MAPSE<1cmon admission categorized into one group (n=20, 38%) and those presenting with MAPSE-1cm(n=33, 62%) categorized into another group. Preliminary results indicated that patients with an MAPSE<1 cmhad a greater risk of developing thromboembolic events. The long-termmortality was significantly higher in TTS patients with an MAPSE<1 cm. In the multivariate Cox regression analysis, cardiogenic shock (hazard ratio 3.5; 95% confidence interval: 1.2-10.7; P=0.02) and MAPSE<1cm (hazard ratio 5.1; 95% confidence interval: 1.3-19.2; P=0.01) figured as independent predictors of the mortality. Conclusion: Although the short-term mortality rates among TTS patients diagnosed with a reduced MAPSE on admission were as similar as without reduced MAPSE, the long-termmortality rates among TTS patients diagnosed with a reduced MAPSE on admission were significantly higher. There is an urgent need for randomized trials, which could help define uniform clinical management strategies for high-risk TTS patients. [ABSTRACT FROM AUTHOR]

Background and aim: Takotsubo cardiomyopathy (TC) is an important differential diagnosis of coronary artery disease (CAD), mimicking acute coronary syndrome in clinical symptoms, biomarker profiles and ST-elevation in ECG. Absence of occlusive coronary disease is an essential criterion distinguishing both diseases. The aim of the study was to explore the influence of co-existing incidental CAD on poorer clinical outcomes and all-cause mortality in TC. Design, methods and results: Our mono-centric study cohort constituted 114 consecutive patients diagnosed with TC between 2003 and 2015. The primary endpoint was the all-cause mortality. Additionally, we compared the incidence of thromboembolic events, life-threatening arrhythmias, cardiogenic shock and in-hospital death. There was no significant difference in gender distribution or mean age in both groups. Patients diagnosed with a co-existing CAD (n=22), had a more pronounced cardiovascular risk profile. The all-cause mortality among patients with co-existing CAD after a 2-year follow-up was higher than those diagnosed with lone TC (22.7 vs. 5.4 %, P = 0.07). In a multivariate cox regression analysis CAD (HR 3.5, 95 %CI 1.0'11.6; P = 0.04), LVEF ⩽ 35% (HR 3.8, 95% CI 0.0'0.6, P = 0.01) and cardiogenic shock (HR 3.8, 95% CI 1.2'11.3; P = 0.01) were independent predictors of the primary endpoint. Conclusion: Our study reveals that co-existing CAD impairs the outcome in patients with TC. The diagnostic work-up for TC should therefore not necessarily hinge on ruling out CAD. [ABSTRACT FROM AUTHOR]

Background: Takotsubo cardiomyopathy (TTC) is a relevant differential diagnosis in patients presenting with signs of an acute coronary syndrome. Although recent literature has highlighted some salient features of this disorder, there has been little information elucidating the differences in clinical features, electrocardiographic findings, echocardiographic data and TTC-related complications associated with the different variants of TTC. Methods and results: Our institutional database constituted a collective of 114 patients diagnosed with TTC between 2003 and 2015 and these patients were subsequently divided into two groups based on the presence (n=82, 72%) or absence (n=32, 28%) of the apical form of TTC. The protocol for our proposed study was approved by the Ethics Committee of the University Medical Centre in Mannheim. It was noticed that the patients presenting with the apical form of TTC belonged to an older age group as compared to those presenting with the non-apical form (61.1±8.9 years vs. 69.5±11.2; P < 0.01). The QTc interval prolongation at index-event was observed to be quantifiably greater in the 'apical variant' patients group (484.8±57ms vs. 464±34.1 ms; P=0.06). With respect to cardiovascular risk factors, patients with arterial hypertension did have a higher predilection to present with the apical form (63.4% vs. 43.7%; P=0.06), however, the impact of smoking was less pronounced in this patient group (24.4% vs. 50%, P=0.01). Furthermore, our study highlighted a significant impact on ejection fraction (EF), with a compromised left ventricular function (3669% vs. 42.4±9.7%, P < 0.01) and greater involvement of the right ventricle in the apical variant patients group (23% vs. 3%, P=0.04). Patients with the apical form also showed a greater tendency to develop TTC-related complications such as cardiogenic shock and required longer monitoring and care in comparison. Conclusions: The apical and non-apical variants of TTC are manifestations of the same syndrome. They differ significantly, however, in their clinical presentation, related complications and prognosis. [ABSTRACT FROM AUTHOR]