Acute neurological disorders preceding Takotsubo syndrome were associated with a 3.2-fold increased odds of in-hospital mortality (OR 3.20) compared to Takotsubo syndrome without neurological triggers.
Observational (n=2,402)
Yes
Does the presence of an acute neurological disorder worsen outcomes in patients with Takotsubo syndrome?
Acute neurological disorders are a frequent trigger for Takotsubo syndrome and are associated with a distinct clinical profile, more severe myocardial injury, and significantly higher in-hospital and long-term mortality.
Odds Ratio: 3.2 (95% CI 1.93–5.33)
Absolute Event Rate: 17.4% vs 4%
p-value: p=<0.001
Cardiac alterations are frequently observed after acute neurological disorders. Takotsubo syndrome (TTS) represents an acute heart failure syndrome and is increasingly recognized as part of the spectrum of cardiac complications observed after neurological disorders. A systematic investigation of TTS patients with neurological disorders has not been conducted yet. The aim of the study was to expand insights regarding neurological disease entities triggering TTS and to investigate the clinical profile and outcomes of TTS patients after primary neurological disorders. The International Takotsubo Registry is an observational multicenter collaborative effort of 45 centers in 14 countries (ClinicalTrials.gov, identifier NCT01947621). All patients in the registry fulfilled International Takotsubo Diagnostic Criteria. For the present study, patients were included if complete information on acute neurological disorders were available. 2402 patients in whom complete information on acute neurological status were available were analyzed. In 161 patients (6.7%) an acute neurological disorder was identified as the preceding triggering factor. The most common neurological disorders were seizures, intracranial hemorrhage, and ischemic stroke. Time from neurological symptoms to TTS diagnosis was ≤ 2 days in 87.3% of cases. TTS patients with neurological disorders were younger, had a lower female predominance, fewer cardiac symptoms, lower left ventricular ejection fraction, and higher levels of cardiac biomarkers. TTS patients with neurological disorders had a 3.2-fold increased odds of in-hospital mortality compared to TTS patients without neurological disorders. In this large-scale study, 1 out of 15 TTS patients had an acute neurological condition as the underlying triggering factor. Our data emphasize that a wide spectrum of neurological diseases ranging from benign to life-threatening encompass TTS. The high rates of adverse events highlight the need for clinical awareness.
Cammann et al. (Tue,) conducted a observational in Takotsubo syndrome (n=2,402). Acute neurological disorders vs. Takotsubo syndrome without preceding acute neurological disorders was evaluated on In-hospital mortality (OR 3.20, 95% CI 1.93-5.33, p=<0.001). Acute neurological disorders preceding Takotsubo syndrome were associated with a 3.2-fold increased odds of in-hospital mortality (OR 3.20) compared to Takotsubo syndrome without neurological triggers.