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June 27, 2022ESC Heart Failure10 citationsOpen Access

Peri-Operative Takotsubo Syndrome After Non-Cardiac Surgery: A Retrospective Nested Case–Control Study

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Why the study?

What are the clinical characteristics and risk factors associated with peri-operative Takotsubo syndrome in patients undergoing non-cardiac surgery?

Population

100 adult patients who underwent in-hospital non-cardiac surgeries between January 2017 and December 2020.

Design

Case-control

Follow-up

Peri-operative period / in-hospital

Key result

Pre-operative leucocyte count >10 × 10^9/L, haemoglobin <120 g/L, and an RCRI score ≥1 were independently associated with peri-operative Takotsubo syndrome after non-cardiac surgery.

Authors

ZSZhi ShangMZMenglin ZhaoJCJiageng Cai

Discussion

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Overview

May enhance pTTS prediction when added to RCRI; hypothesis-generating from case-control data and needs prospective validation.

Study Design

Type

Case-Control (n=100)

Multicenter

No

Structured PICO

What are the clinical characteristics and risk factors associated with peri-operative Takotsubo syndrome in patients undergoing non-cardiac surgery?

P
Population
100 adult patients (20 cases with peri-operative Takotsubo syndrome and 80 matched controls without) who underwent in-hospital non-cardiac surgeries between January 2017 and December 2020.
C
Comparator
Matched control patients who did not develop Takotsubo syndrome during the peri-operative period (matched 1:4 based on operative type).
O
Outcome
Factors associated with peri-operative Takotsubo syndrome (pTTS) and the diagnostic efficacy (AUC) of the revised cardiac risk index (RCRI) score with and without leucocyte count and hemoglobin.

Peri-operative Takotsubo syndrome is a rare but severe complication of non-cardiac surgery, and its prediction can be significantly improved by adding leukocyte count and hemoglobin levels to the standard Revised Cardiac Risk Index.

Main Result

Effect estimate: OR 4.59 (95% CI 1.10-19.15)

p-value: p=0.036

Limitations

  • Retrospective single-center design may limit generalizability due to institution-specific clinical practices
  • Small sample size of the event group (20 cases) may lead to missed patients due to insufficient clinical data
  • Potential unknown confounding factors could have introduced bias despite matching for known risk factors
  • Reliance on ICD-10 codes for diagnosis may underestimate the true incidence rate

Cite This Study

Shang et al. (2022) conducted a case-control in Peri-operative Takotsubo syndrome (pTTS) (n=100). Pre-operative risk factors (Leucocyte count, Haemoglobin, RCRI score) vs. Matched controls without pTTS was evaluated on Association of leucocyte count >10 × 10^9/L with peri-operative Takotsubo syndrome (OR 4.59, 95% CI 1.10-19.15, p=0.036). Pre-operative leucocyte count >10 × 10^9/L, haemoglobin <120 g/L, and an RCRI score ≥1 were independently associated with peri-operative Takotsubo syndrome after non-cardiac surgery.

synapsesocial.com/papers/6a0a594b97b2cd65685918e5https://doi.org/10.1002/ehf2.14015
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Surgery as precipitating factor of takotsubo cardiomyopathy, characteristics and challenges: A case series2024
  2. 2Takotsubo Syndrome: Clinical and Diagnostic Characteristics of 26 Consecutively Hospitalized Patients Over a Five-Year Period2026
  3. 3Long-Term Prognosis in Patients with Takotsubo Syndrome2019 · 14 citations
  4. 4Impact and management of left ventricular function on the prognosis of Takotsubo syndrome2017 · 17 citations
  5. 5Takotsubo syndrome in the 21st century: a portuguese picture from a tertiary center2025