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1. Prediction of short‐ and long‐term mortality in takotsubo syndrome: the InterTAK Prognostic Score

Author

Thomas Münzel, Yoshio Kobayashi, Wolfgang Koenig, Hugo A. Katus, Paul Bridgman, Christina Chan, Ioana Sorici-Barb, Eduardo Bossone, Gregor Poglajen, Abhiram Prasad, Fabrizio D'Ascenzo, Jelena R. Ghadri, Monika Budnik, Konrad A. Szawan, Fausto J. Pinto, David E. Winchester, Guido Michels, Carlo Di Mario, Thomas Fischer, Matteo Bianco, Jerold S. Shinbane, Burkert Pieske, Alessandro Candreva, Rodolfo Citro, P. Christian Schulze, Annahita Sarcon, Kan Liu, Christian Ukena, Christoph Kaiser, Martin Borggrefe, Florim Cuculi, Stefan Osswald, Behrouz Kherad, Heribert Schunkert, Jeroen J. Bax, Maike Knorr, Ken Kato, Petr Widimský, Alexandra Shilova, Frank Ruschitzka, Martin Kozel, Victoria L. Cammann, Roman Pfister, Olivier Lairez, Michael Neuhaus, Alessandro Cuneo, Wolfgang Rottbauer, Ibrahim Akin, Lucas Jörg, Christian Hauck, L. Christian Napp, Holger Thiele, Manfred Wischnewsky, K.E. Juhani Airaksinen, Hans Rickli, Tuija Vasankari, Carla Paolini, Lars S. Maier, Philippe Meyer, Adrian P. Banning, Richard Kobza, Beatrice Bacchi, Miłosz Jaguszewski, Rafal Dworakowski, Michael Böhm, Claudio Bilato, Mahir Karakas, Philip MacCarthy, Mikhail Gilyarov, Charanjit S. Rihal, Alexander Pott, Claudius Jacobshagen, Clément Delmas, Jose David Arroja, Ibrahim El-Battrawy, Filippo Crea, Carsten Tschöpe, Pedro Carrilho-Ferreira, Ekaterina Gilyarova, Jennifer Franke, Daniel Beug, Ruediger C. Braun-Dullaeus, John D. Horowitz, Thanh H Nguyen, Sebastiano Gili, Christof Burgdorf, Jan Galuszka, Leonarda Galiuto, Grzegorz Opolski, Susanne Heiner, Johann Bauersachs, Christian Templin, Petr Tousek, Michel Noutsias, Lawrence Rajan, Stephan B. Felix, Wolfgang Dichtl, Thomas F. Lüscher, Gerd Hasenfuß, Wischnewsky, Mb, Candreva, A, Bacchi, B, Cammann, Vl, Kato, K, Szawan, Ka, Gili, S, D'Ascenzo, F, Dichtl, W, Citro, R, Bossone, E, Neuhaus, M, Franke, J, Sorici-Barb, I, Jaguszewski, M, Noutsias, M, Knorr, M, Heiner, S, Burgdorf, C, Kherad, B, Tschope, C, Sarcon, A, Shinbane, J, Rajan, L, Michels, G, Pfister, R, Cuneo, A, Jacobshagen, C, Karakas, M, Koenig, W, Pott, A, Meyer, P, Arroja, Jd, Banning, A, Cuculi, F, Kobza, R, Fischer, Ta, Vasankari, T, Airaksinen, Kej, Napp, Lc, Budnik, M, Dworakowski, R, Maccarthy, P, Kaiser, C, Osswald, S, Galiuto, L, Chan, C, Bridgman, P, Beug, D, Delmas, C, Lairez, O, El-Battrawy, I, Akin, I, Gilyarova, E, Shilova, A, Gilyarov, M, Kozel, M, Tousek, P, Winchester, De, Galuszka, J, Ukena, C, Poglajen, G, Carrilho-Ferreira, P, Hauck, C, Paolini, C, Bilato, C, Prasad, A, Rihal, C, Liu, K, Schulze, Pc, Bianco, M, Jorg, L, Rickli, H, Nguyen, Th, Kobayashi, Y, Bohm, M, Maier, L, Pinto, Fj, Widimsky, P, Borggrefe, M, Felix, Sb, Opolski, G, Braun-Dullaeus, Rc, Rottbauer, W, Hasenfuss, G, Pieske, Bm, Schunkert, H, Thiele, H, Bauersachs, J, Katus, Ha, Horowitz, J, Di Mario, C, Munzel, T, Crea, F, Bax, Jj, Luscher, Tf, Ruschitzka, F, Ghadri, Jr, Templin, C, and Repositório da Universidade de Lisboa

Subjects
Male, Research design, medicine.medical_specialty, MEDLINE, 030204 cardiovascular system & hematology, Prognostic score, 03 medical and health sciences, 0302 clinical medicine, Risk Factors, Takotsubo Cardiomyopathy, Internal medicine, medicine, Humans, 030212 general & internal medicine, Survival analysis, Aged, Aged, 80 and over, Takotsubo syndrome, business.industry, Stroke Volume, Stroke volume, Middle Aged, Prognosis, medicine.disease, Survival Analysis, 3. Good health, Research Design, Heart failure, Cardiology, Female, Long term mortality, Cardiology and Cardiovascular Medicine, business
Abstract

© 2019 The Authors European Journal of Heart Failure © 2019 European Society of Cardiology, Recent evidence suggests comparable in‐hospital and long‐term outcomes between takotsubo syndrome (TTS) and acute coronary syndrome. Medical scoring systems are practical tools for decision making and prognostic assessment. However, TTS‐specific scoring systems for risk stratification have not yet been established. Recently, classification based on triggering conditions proved useful in predicting adverse outcomes in TTS (InterTAK Classification).1 Since clinical parameters other than triggering conditions can be associated with adverse outcomes in TTS, such as systolic blood pressure and heart rate, the present study aimed to establish a scoring system combining triggering factors with other important but easily‐ obtainable clinical parameters of daily clinical practice., C.T. has been supported by the H.H. Sheikh Khalifa bin Hamad Al-Thani Research Programme and the Swiss Heart Foundation. L.S.M. was supported by EU HORIZON 2020 (SILICOFCM ID777204). The InterTAK Registry is supported by the Biss Davies Charitable Trust.

Published
2019
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2. Prognostic impact of acute pulmonary triggers in patients with Takotsubo syndrome : new insights from the International Takotsubo Registry

Author

Wolfgang Koenig, John D. Horowitz, Hugo A. Katus, Paul Bridgman, Abhiram Prasad, Carlo Di Mario, Alessandro Cuneo, Johann Bauersachs, Jeroen J. Bax, Mathias Wolfrum, Carsten Tschöpe, Masanori Sano, Vanya Petkova, Lucas Jörg, Fausto J. Pinto, Petr Widimský, Masayuki Takahara, Rodolfo Citro, Iwao Ishibashi, Frank Ruschitzka, Thomas Münzel, Carmine Vecchione, Wolfgang Dichtl, Jan Galuszka, Kan Liu, Leonarda Galiuto, Grzegorz Opolski, Jozef Micek, Susanne Heiner, Florim Cuculi, Gerd Hasenfuß, Jerold S. Shinbane, Maike Knorr, Sebastiano Gili, Filippo Crea, Michael Würdinger, Alexandra Shilova, Malcolm Kohler, Lawrence Rajan, Christian F Clarenbach, Rena A. Levinson, Mikhail Gilyarov, Alexander Pott, Roman Pfister, Ekaterina Gilyarova, Claudius Jacobshagen, Adrian P. Banning, Michael Neuhaus, Jennifer Franke, Christian Templin, Christof Burgdorf, Daniel Beug, K.E. Juhani Airaksinen, Victoria L. Cammann, Thanh H Nguyen, Rafael Sumalinog, Monika Budnik, Wolfgang Rottbauer, Yoshio Kobayashi, Petr Tousek, Stephan B. Felix, Marco Roffi, Michael Böhm, Konrad A. Szawan, Toshiharu Himi, Ibrahim Akin, Christina Chan, Thomas F. Lüscher, Rafal Dworakowski, Annahita Sarcon, Ibrahim El-Battrawy, Miłosz Jaguszewski, Alexandru Patrascu, Eduardo Bossone, David E. Winchester, Michel Noutsias, Guido Michels, Gregor Poglajen, Christian Hauck, Fabrizio D'Ascenzo, Burkert Pieske, Christian Ukena, Thomas Fischer, Matteo Bianco, Lars S. Maier, Christoph Kaiser, Philippe Meyer, P. Christian Schulze, Behrouz Kherad, Gonçalo Pestana, Claudio Bilato, Ken Kato, Martin Kozel, Charanjit S. Rihal, Clément Delmas, Stefan Osswald, Olivier Lairez, Jelena R. Ghadri, Martin Borggrefe, Philip MacCarthy, Heribert Schunkert, Manfred Wischnewsky, Sara Dreiding, Hans Rickli, Tuija Vasankari, L. Christian Napp, Holger Thiele, Richard Kobza, Carla Paolini, Benjamin Meder, Mahir Karakas, Pedro Carrilho-Ferreira, Ruediger C. Braun-Dullaeus, Kato, K., Cammann, V. L., Napp, L. C., Szawan, K. A., Micek, J., Dreiding, S., Levinson, R. A., Petkova, V., Wurdinger, M., Patrascu, A., Sumalinog, R., Gili, S., Clarenbach, C. F., Kohler, M., Wischnewsky, M., Citro, R., Vecchione, C., Bossone, E., Neuhaus, M., Franke, J., Meder, B., Jaguszewski, M., Noutsias, M., Knorr, M., Heiner, S., D'Ascenzo, F., Dichtl, W., Burgdorf, C., Kherad, B., Tschope, C., Sarcon, A., Shinbane, J., Rajan, L., Michels, G., Pfister, R., Cuneo, A., Jacobshagen, C., Karakas, M., Koenig, W., Pott, A., Meyer, P., Roffi, M., Banning, A., Wolfrum, M., Cuculi, F., Kobza, R., Fischer, T. A., Vasankari, T., Airaksinen, K. E. J., Budnik, M., Dworakowski, R., Maccarthy, P., Kaiser, C., Osswald, S., Galiuto, L., Chan, C., Bridgman, P., Beug, D., Delmas, C., Lairez, O., Gilyarova, E., Shilova, A., Gilyarov, M., El-Battrawy, I., Akin, I., Kozel, M., Tousek, P., Winchester, D. E., Galuszka, J., Ukena, C., Poglajen, G., Carrilho-Ferreira, P., Hauck, C., Paolini, C., Bilato, C., Sano, M., Ishibashi, I., Takahara, M., Himi, T., Kobayashi, Y., Prasad, A., Rihal, C. S., Liu, K., Schulze, P. C., Bianco, M., Jorg, L., Rickli, H., Pestana, G., Nguyen, T. H., Bohm, M., Maier, L. S., Pinto, F. J., Widimsky, P., Felix, S. B., Opolski, G., Braun-Dullaeus, R. C., Rottbauer, W., Hasenfuss, G., Pieske, B. M., Schunkert, H., Borggrefe, M., Thiele, H., Bauersachs, J., Katus, H. A., Horowitz, J. D., Di Mario, C., Munzel, T., Crea, F., Bax, J. J., Luscher, T. F., Ruschitzka, F., Ghadri, J. R., Templin, C., and Repositório da Universidade de Lisboa

Subjects
medicine.medical_specialty, Acute respiratory insufficiency, acute respiratory insufficiency, Shock, Cardiogenic, 030204 cardiovascular system & hematology, Broken heart syndrome, chronic obstructive pulmonary disease, 03 medical and health sciences, 0302 clinical medicine, Takotsubo Cardiomyopathy, Original Research Articles, Internal medicine, medicine, Humans, Diseases of the circulatory (Cardiovascular) system, takotsubo syndrome, Registries, Original Research Article, 030212 general & internal medicine, Survival analysis, Outcome, Takotsubo syndrome, intertak registry, business.industry, InterTAK Registry, Incidence (epidemiology), Cardiogenic shock, Chronic obstructive pulmonary disease, Hazard ratio, broken heart syndrome, Shock, Cardiogenic, Prognosis, medicine.disease, Survival Analysis, outcome, Confidence interval, 3. Good health, RC666-701, Heart failure, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Cardiology and Cardiovascular Medicine, business
Abstract

© 2021 The Authors. ESC Heart Failure published by John Wiley & Sons Ltd on behalf of European Society of Cardiology. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License., 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., C. T. has been supported by the H.H. Sheikh Khalifa binHamad Al-Thani Research Programme and the Swiss HeartFoundation. The InterTAK Registry is supported by the BissDavies Charitable Trust. L. S. M. has been supported by EUHORIZON 2020(SILICOFCM ID777204)

Published
2021

3. Long-Term Prognosis of Patients With Takotsubo Syndrome

Author

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

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

Background Prognosis of Takotsubo syndrome (TTS) remains controversial due to scarcity of available data. Additionally, the effect of the triggering factors remains elusive. Objectives This study compared prognosis between TTS and acute coronary syndrome (ACS) patients and investigated short- and long-term outcomes in TTS based on different triggers. Methods Patients with TTS were enrolled from the International Takotsubo Registry. Long-term mortality of patients with TTS was compared to an age- and sex-matched cohort of patients with ACS. In addition, short- and long-term outcomes were compared between different groups according to triggering conditions. Results Overall, TTS patients had a comparable long-term mortality risk with ACS patients. Of 1,613 TTS patients, an emotional trigger was detected in 485 patients (30%). Of 630 patients (39%) related to physical triggers, 98 patients (6%) had acute neurologic disorders, while in the other 532 patients (33%), physical activities, medical conditions, or procedures were the triggering conditions. The remaining 498 patients (31%) had no identifiable trigger. TTS patients related to physical stress showed higher mortality rates than ACS patients during long-term follow-up, whereas patients related to emotional stress had better outcomes compared with ACS patients. Conclusions Overall, TTS patients had long-term outcomes comparable to age- and sex-matched ACS patients. Also, we demonstrated that TTS can either be benign or a life-threating condition depending on the inciting stress factor. We propose a new classification based on triggers, which can serve as a clinical tool to predict short- and long-term outcomes of TTS. (International Takotsubo Registry [InterTAK Registry]; NCT01947621)

Published
2018

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

Author

Christian Templin, Antonio H. Frangieh, John D. Horowitz, Rodolfo Citro, Johann Bauersachs, Petr Widimský, Philip MacCarthy, David E. Winchester, Andrea Saglietto, Alessandro Cuneo, Guido Michels, Ekaterina Gilyarova, Burkert Pieske, Christian Ukena, Frank Ruschitzka, Christoph Kaiser, Mauro Gasparini, Mario Iannaccone, Wolfgang Koenig, Eduardo Bossone, Gaetano M. De Ferrari, Miłosz Jaguszewski, Florim Cuculi, Jeroen J. Bax, Wolfgang-Michael Franz, Leonarda Galiuto, L. Christian Napp, Grzegorz Opolski, Holger Thiele, Susanne Heiner, Abhiram Prasad, Carlo Di Mario, Stephan B. Felix, Thomas Münzel, Margherita Annaratone, Roman Pfister, Thomas F. Lüscher, Adrian P. Banning, Ruediger C. Braun-Dullaeus, Konrad A. Szawan, K.E. Juhani Airaksinen, Mahir Karakas, Michael Böhm, Victoria L. Cammann, Gerd Hasenfuß, Wolfgang Rottbauer, Rena A. Levinson, Samir M. Said, Ibrahim Akin, Fabrizio D'Ascenzo, Lawrence Rajan, Maike Knorr, Thomas Fischer, Rafal Dworakowski, Mikhail Gilyarov, Maurizio Bertaina, Annahita Sarcon, Mauro Rinaldi, Ken Kato, Martin Kozel, Wolfgang Dichtl, Carsten Tschöpe, Hugo A. Katus, Filippo Crea, Clément Delmas, Jennifer Franke, Giuseppe Biondi-Zoccai, Claudius Jacobshagen, Ibrahim El-Battrawy, Alexandra Shilova, Sebastiano Gili, Davide Di Vece, Beatrice Boffini, Michael Neuhaus, Christof Burgdorf, Petr Tousek, Jelena R. Ghadri, Martin Borggrefe, Stefan Osswald, Olivier Lairez, Richard Kobza, Heribert Schunkert, Klaus Empen, Tuija Vasankari, Michel Noutsias, D'Ascenzo, F., Gili, S., Bertaina, M., Iannaccone, M., Cammann, V. L., Di Vece, D., Kato, K., Saglietto, A., Szawan, K. A., Frangieh, A. H., Boffini, B., Annaratone, M., Sarcon, A., Levinson, R. A., Franke, J., Napp, L. C., Jaguszewski, M., Noutsias, M., Munzel, T., Knorr, M., Heiner, S., Katus, H. A., Burgdorf, C., Schunkert, H., Thiele, H., Bauersachs, J., Tschope, C., Pieske, B. M., Rajan, L., Michels, G., Pfister, R., Cuneo, A., Jacobshagen, C., Hasenfuss, G., Karakas, M., Koenig, W., Rottbauer, W., Said, S. M., Braun-Dullaeus, R. C., Banning, A., Cuculi, F., Kobza, R., Fischer, T. A., Vasankari, T., Airaksinen, K. E. J., Opolski, G., Dworakowski, R., Maccarthy, P., Kaiser, C., Osswald, S., Galiuto, L., Crea, F., Dichtl, W., Franz, W. M., Empen, K., Felix, S. B., Delmas, C., Lairez, O., El-Battrawy, I., Akin, I., Borggrefe, M., Horowitz, J. D., Kozel, M., Tousek, P., Widimsky, P., Gilyarova, E., Shilova, A., Gilyarov, M., Biondi-Zoccai, G., Winchester, D. E., Ukena, C., Neuhaus, M., Bax, J. J., Prasad, A., Di Mario, C., Bohm, M., Gasparini, M., Ruschitzka, F., Bossone, E., Citro, R., Rinaldi, M., De Ferrari, G. M., Luscher, T., Ghadri, J. R., and Templin, C.

Subjects
medicine.medical_specialty, Medical therapy, Acute heart failure, Aspirin, Outcome, Takotsubo syndrome, Myocardial Infarction, 030204 cardiovascular system & hematology, law.invention, 03 medical and health sciences, 0302 clinical medicine, Randomized controlled trial, Recurrence, Takotsubo Cardiomyopathy, law, Internal medicine, medicine, Humans, Registries, Myocardial infarction, Propensity Score, Stroke, Heart Failure, business.industry, Hazard ratio, medicine.disease, Confidence interval, 3. Good health, Treatment Outcome, Ischemic Attack, Transient, Heart failure, Propensity score matching, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Cardiology, Cardiology and Cardiovascular Medicine, business, Platelet Aggregation Inhibitors, medicine.drug
Abstract

Aims The aim of the present study was to investigate the impact of aspirin on prognosis in takotsubo syndrome (TTS). Methods and results Patients 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. Conclusion In 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. ClinicalTrials.gov Identifier: NCT01947621.

Published
2020

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

Author

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

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

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

Published
2020

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

Author

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

Subjects
Male, medicine.medical_specialty, Time Factors, outcome, recovery, takotsubo syndrome, wall motion abnormalities, MEDLINE, 030204 cardiovascular system & hematology, Wall motion abnormalities, 03 medical and health sciences, 0302 clinical medicine, Takotsubo Cardiomyopathy, Recovery, Medicine, Humans, 030212 general & internal medicine, Wall motion, Prospective Studies, Registries, Intensive care medicine, Aged, Retrospective Studies, Original Research, Outcome, Heart Failure, Takotsubo syndrome, business.industry, Creative commons, Recovery of Function, Middle Aged, Prognosis, 3. Good health, ddc, Female, Cardiology and Cardiovascular Medicine, business, Switzerland
Abstract

© 2019 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. This is an open access article under the terms of the Creative Commons Attribution-NonCommercial License, which permits use, distribution and reproduction in any medium, provided the original work is properly cited and is not used for commercial purposes., 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, Christian Templin was supported by the H.H. Sheikh Khalifa bin Hamad Al‐Thani Research Programme and the Swiss Heart Foundation. The InterTAK Registry is supported by the Biss Davies Charitable Trust.

Published
2019

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

Author

Jelena R. Ghadri, Pedro Carrilho-Ferreira, Wolfgang Koenig, Carla Paolini, Adrian P. Banning, Alessandro Cuneo, Jeroen J. Bax, Petr Widimský, Manfred Wischnewsky, Yoichi Imori, Hugo A. Katus, Paul Bridgman, Martin Borggrefe, Tuija Vasankari, David E. Winchester, Annahita Sarcon, Abhiram Prasad, Alexander Pott, Claudius Jacobshagen, Sebastiano Gili, John D. Horowitz, Heribert Schunkert, Frank Ruschitzka, Stephan B. Felix, Michael Böhm, Guido Michels, Lars S. Maier, Fausto J. Pinto, Carlo Di Mario, Ruediger C. Braun-Dullaeus, Thomas F. Lüscher, Philippe Meyer, Lawrence Rajan, Burkert Pieske, Thomas Münzel, Stefan Osswald, Gerd Hasenfuß, Rodolfo Citro, Olivier Lairez, Mahir Karakas, Florim Cuculi, Christian Ukena, Victoria L. Cammann, Alexandra Shilova, Jose David Arroja, Leonarda Galiuto, Grzegorz Opolski, Christoph Kaiser, Wolfgang Rottbauer, Christian Templin, Carsten Tschöpe, Ibrahim Akin, Ioana Sorici-Barb, Susanne Heiner, Jennifer Franke, Fabrizio D'Ascenzo, Johann Bauersachs, Richard Kobza, Christof Burgdorf, Michael Neuhaus, P. Christian Schulze, Daniel Beug, Petr Tousek, Filippo Crea, Monika Budnik, Miłosz Jaguszewski, Roman Pfister, Konrad A. Szawan, Ekaterina Gilyarova, Philip MacCarthy, Wolfgang Dichtl, Yoshio Kobayashi, Jan Galuszka, Michel Noutsias, Christina Chan, Thomas Fischer, Matteo Bianco, Ibrahim El-Battrawy, L. Christian Napp, Holger Thiele, Karolina Polednikova, Claudio Bilato, Charanjit S. Rihal, Clément Delmas, Rafal Dworakowski, Mikhail Gilyarov, Eduardo Bossone, Gregor Poglajen, Behrouz Kherad, Ken Kato, Christian Hauck, Maike Knorr, Eugene Braunwald, K.E. Juhani Airaksinen, Christian Napp, L., Cammann, V. L., Jaguszewski, M., Szawan, K. A., Wischnewsky, M., Gili, S., Knorr, M., Heiner, S., Citro, R., Bossone, E., D'Ascenzo, F., Neuhaus, M., Franke, J., Sorici-Barb, I., Noutsias, M., Burgdorf, C., Koenig, W., Kherad, B., Sarcon, A., Rajan, L., Michels, G., Pfister, R., Cuneo, A., Jacobshagen, C., Karakas, M., Pott, A., Meyer, P., Arroja, J. D., Banning, A., Cuculi, F., Kobza, R., Fischer, T. A., Vasankari, T., Juhani Airaksinen, K. E., Hauck, C., Paolini, C., Bilato, C., Imori, Y., Kato, K., Kobayashi, Y., Opolski, G., Budnik, M., Dworakowski, R., Maccarthy, P., Kaiser, C., Osswald, S., Galiuto, L., Dichtl, W., Chan, C., Bridgman, P., Beug, D., Delmas, C., Lairez, O., El-Battrawy, I., Akin, I., Gilyarova, E., Shilova, A., Gilyarov, M., Horowitz, J. D., Polednikova, K., Tousek, P., Widimsky, P., Winchester, D. E., Galuszka, J., Ukena, C., Poglajen, G., Carrilho-Ferreira, P., Mario, C. D., Prasad, A., Rihal, C. S., Christian Schulze, P., Bianco, M., Crea, F., Borggrefe, M., Maier, L. S., Pinto, F. J., Braun-Dullaeus, R. C., Rottbauer, W., Katus, H. A., Hasenfuss, G., Tschope, C., Pieske, B. M., Thiele, H., Schunkert, H., Bohm, M., Felix, S. B., Munzel, T., Bax, J. J., Bauersachs, J., Braunwald, E., Luscher, T. F., Ruschitzka, F., Ghadri, J. R., Templin, C., and Repositório da Universidade de Lisboa

Subjects
medicine.medical_specialty, Acute coronary syndrome, medicine.medical_treatment, Coronary Artery Disease, 030204 cardiovascular system & hematology, Coronary Angiography, Coronary artery disease, 03 medical and health sciences, 0302 clinical medicine, Takotsubo Cardiomyopathy, Internal medicine, medicine, Humans, 030212 general & internal medicine, Myocardial infarction, Acute Coronary Syndrome, 10. No inequality, Cardiac catheterization, Outcome, medicine.diagnostic_test, business.industry, Incidence, Percutaneous coronary intervention, medicine.disease, 3. Good health, Coronary occlusion, Heart failure, Angiography, Cardiology, Cardiology and Cardiovascular Medicine, business, Takotsubo syndrome
Abstract

Copyright © 2020 European Society of Cardiology, Aims: Takotsubo syndrome (TTS) 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 TTS patients. This study aimed to determine the coexistence, features, and prognostic role of CAD in a large cohort of patients with TTS. Methods and results: Coronary anatomy and CAD were studied in patients diagnosed with TTS. 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 TTS 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 TTS, 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 TTS patients, presents with the whole spectrum of coronary pathology including acute coronary occlusion, and is associated with adverse outcome.

Published
2019

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

Author

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

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

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

Published
2019

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

Author

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

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

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

Published
2019

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

Author

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

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

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

Published
2019

11. Age -Related Variations in Takotsubo Syndrome

Author

Behrouz Kherad, Roman Pfister, Ken Kato, Stefan Osswald, Thanh H Nguyen, Benjamin Meder, Alessandro Cuneo, Toshiharu Himi, Stephan B. Felix, Marco Roffi, Lawrence Rajan, Thomas F. Lüscher, David E. Winchester, Sebastiano Gili, Gerd Hasenfuß, Guido Michels, Ibrahim El-Battrawy, Petr Widimský, Olivier Lairez, Victoria L. Cammann, Rafal Dworakowski, Eduardo Bossone, Mahir Karakas, Charanjit S. Rihal, Burkert Pieske, Barbara E. Stähli, Gregor Poglajen, Wolfgang Rottbauer, Leonarda Galiuto, Grzegorz Opolski, Christian Ukena, Susanne Heiner, Christoph Kaiser, Christian Hauck, Filippo Crea, Wolfgang Koenig, Ibrahim Akin, Christof Burgdorf, Carsten Tschöpe, Clément Delmas, Yoshio Kobayashi, K.E. Juhani Airaksinen, Florim Cuculi, Mikhail Gilyarov, Pedro Carrilho-Ferreira, Masayuki Takahara, Ali Al-Shammari, Christina Chan, Jerold S. Shinbane, Miłosz Jaguszewski, Hugo A. Katus, Fabrizio D'Ascenzo, Wolfgang Dichtl, Jehangir Din, Paul Bridgman, John D. Horowitz, Toshihiro Shoji, Jan Galuszka, Monika Budnik, Claudio Bilato, Jelena R. Ghadri, Alexander Pott, Christian Templin, Konrad A. Szawan, Claudius Jacobshagen, Ruediger C. Braun-Dullaeus, Gonçalo Pestana, Abhiram Prasad, Carlo Di Mario, Fausto J. Pinto, Maike Knorr, Iwao Ishibashi, Thomas Münzel, Lars S. Maier, Jennifer Franke, Mathias Wolfrum, Adrian P. Banning, Philippe Meyer, Kan Liu, Alexandra Shilova, Davide Di Vece, Daniel Beug, Michael Neuhaus, Martin Borggrefe, Michael Böhm, Annahita Sarcon, Heribert Schunkert, Petr Tousek, Rena A. Levinson, Ekaterina Gilyarova, Frank Ruschitzka, Carla Paolini, Michel Noutsias, Richard Kobza, Thomas Fischer, Matteo Bianco, P. Christian Schulze, Lucas Jörg, Manfred Wischnewsky, Sara Dreiding, Hans Rickli, Tuija Vasankari, Rodolfo Citro, Jeroen J. Bax, Philip MacCarthy, L. Christian Napp, Holger Thiele, Karolina Polednikova, Johann Bauersachs, Repositório da Universidade de Lisboa, Cammann, V. L., Szawan, K. A., Stahli, B. E., Kato, K., Budnik, M., Wischnewsky, M., Dreiding, S., Levinson, R. A., Di Vece, D., Gili, S., Citro, R., Bossone, E., Neuhaus, M., Franke, J., Meder, B., Jaguszewski, M., Noutsias, M., Knorr, M., Heiner, S., D'Ascenzo, F., Dichtl, W., Burgdorf, C., Kherad, B., Tschope, C., Sarcon, A., Shinbane, J., Rajan, L., Michels, G., Pfister, R., Cuneo, A., Jacobshagen, C., Karakas, M., Koenig, W., Pott, A., Meyer, P., Roffi, M., Banning, A., Wolfrum, M., Cuculi, F., Kobza, R., Fischer, T. A., Vasankari, T., Airaksinen, K. E. J., Napp, L. C., Dworakowski, R., Maccarthy, P., Kaiser, C., Osswald, S., Galiuto, L., Chan, C., Bridgman, P., Beug, D., Delmas, C., Lairez, O., Gilyarova, E., Shilova, A., Gilyarov, M., El-Battrawy, I., Akin, I., Polednikova, K., Tousek, P., Winchester, D. E., Galuszka, J., Ukena, C., Poglajen, G., Carrilho-Ferreira, P., Hauck, C., Paolini, C., Bilato, C., Kobayashi, Y., Shoji, T., Ishibashi, I., Takahara, M., Himi, T., Din, J., Al-Shammari, A., Prasad, A., Rihal, C. S., Liu, K., Schulze, P. C., Bianco, M., Jorg, L., Rickli, H., Pestana, G., Nguyen, T. H., Bohm, M., Maier, L. S., Pinto, F. J., Widimsky, P., Felix, S. B., Braun-Dullaeus, R. C., Rottbauer, W., Hasenfuss, G., Pieske, B. M., Schunkert, H., Borggrefe, M., Thiele, H., Bauersachs, J., Katus, H. A., Horowitz, J. D., Di Mario, C., Munzel, T., Crea, F., Bax, J. J., Luscher, T. F., Ruschitzka, F., Ghadri, J. R., Opolski, G., and Templin, C.

Subjects
Male, Pediatrics, medicine.medical_specialty, Shock, Cardiogenic, Hospital mortality, 030204 cardiovascular system & hematology, age, broken heart syndrome, outcome, takotsubo syndrome, Global Health, Risk Assessment, Broken heart syndrome, 03 medical and health sciences, 0302 clinical medicine, Age, Takotsubo Cardiomyopathy, Intensive care, Age related, Prevalence, Medicine, Humans, 030212 general & internal medicine, Registries, Hospital Mortality, Mortality, Age of Onset, Aged, Outcome, Takotsubo syndrome, business.industry, Mental Disorders, Age Factors, Shock, Middle Aged, medicine.disease, Prognosis, Cardiogenic, 3. Good health, Causality, Baseline characteristics, Settore MED/11 - MALATTIE DELL'APPARATO CARDIOVASCOLARE, Female, Age of onset, Nervous System Diseases, Cardiology and Cardiovascular Medicine, business
Abstract

© 2020 by the American College of Cardiology Foundation., BACKGROUND: Takotsubo syndrome (TTS) occurs predominantly in post-menopausal women but is also found in younger patients. OBJECTIVES: This study aimed to investigate age-related differences in TTS. METHODS: Patients diagnosed with TTS and enrolled in the International Takotsubo Registry between January 2011 and February 2017 were included in this analysis and were stratified by age (younger: #50 years, middle-age: 51 to 74 years, elderly: $75 years). Baseline characteristics, hospital course, as well as short- and long-term mortality were compared among groups. RESULTS Of 2,098 TTS patients, 242 (11.5%) patients were #50 years of age, 1,194 (56.9%) were 51 to 74 years of age, and 662 (31.6%) were $75 years of age. Younger patients were more often men (12.4% vs. 10.9% vs. 6.3%; p ¼ 0.002) and had an increased prevalence of acute neurological (16.3% vs. 8.4% vs. 8.8%; p ¼ 0.001) or psychiatric disorders (14.1% vs. 10.3% vs. 5.6%; p < 0.001) compared with middle-aged and elderly TTS patients. Furthermore, younger patients had more often cardiogenic shock (15.3% vs. 9.1% vs. 8.1%; p ¼ 0.004) and had a numerically higher in-hospital mortality (6.6% vs. 3.6% vs. 5.1%; p ¼ 0.07). At multivariable analysis, younger (odds ratio: 1.60; 95% confidence interval: 0.86 to 3.01; p ¼ 0.14) and older age (odds ratio: 1.09; 95% confidence interval: 0.66 to 1.80; p ¼ 0.75) were not independently associated with in-hospital mortality using the middle-aged group as a reference. There were no differences in 60-day mortality rates among groups. CONCLUSIONS: A substantial proportion of TTS patients are younger than 50 years of age. TTS is associated with severe complications requiring intensive care, particularly in younger patients.

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