Recurrence of Takotsubo Syndrome　― Incidence and Clinical Characteristics ―

Background: Although takotsubo syndrome (TTS) carries a substantial risk of recurrence, the factors associated with recurrence remain uncertain. Methods and Results: A total of 236 consecutive patients with TTS (age 80 years [interquartile range (IQR) 71-85]), admitted between 2008 and 2023, were studied. The recurrence group (n=13; age 78 years [IQR 70-84]) was compared with the non-recurrence group (n=223, age 80 years [IQR 71-85]) based on clinical features at the initial TTS event. The recurrence rate was 5.5%. The absence of a definable trigger was more frequent (85% vs. 20%; P<0.001), and physical triggers were less frequent (0% vs. 64%; P<0.001) in the recurrence group. Of the initial diagnostic clues, chest pain/dyspnea was more frequent (77% vs. 35%; P=0.002), and electrocardiographic changes were less frequent (23% vs. 61%; P=0.006) in the recurrence group. A ballooning pattern was similar between episodes in 12 of the 13 patients with recurrence. In the multivariate analysis, the absence of a definable trigger (odds ratio 15.47 [95% confidence interval 3.10-77.60]; P<0.001) was associated with recurrence. Conclusions: The recurrence rate of TTS was 5.5% over the 16-year period. Ballooning patterns at recurrence were largely similar to those at the initial TTS event. Patients who experienced TTS without a definable trigger had more frequent recurrences than those with identifiable triggers.