A history of malignancy in patients with takotsubo cardiomyopathy was associated with a significantly higher risk of overall mortality (HR 2.62) compared to patients without a history of malignancy.
Cohort (n=154)
No
Does a previous or current diagnosis of malignancy increase the risk of death in patients with takotsubo cardiomyopathy?
A history of malignancy in patients with takotsubo cardiomyopathy is associated with higher inflammatory markers and is an independent predictor of both cardiac and overall mortality.
Hazard Ratio: 2.62 (95% CI 1.26–5.44)
Absolute Event Rate: 45.5% vs 19.1%
p-value: p=0.010
BACKGROUND: Although the relationship between malignancies and catecholamine-induced myocardial stunning remains largely speculative, it has been suggested that the presence of cancer may lower the threshold for stress stimuli and/or may aggravate cardiac adrenoreceptor sensitivity. We sought to investigate whether associations exist between a previous or current diagnosis of malignancy, diagnostic parameters during hospitalization and death in takotsubo. METHODS AND RESULTS: The 154 takotsubo patients were retrospectively identified between May 2008 and December 2014. Previous history of malignancy was identified in 44 patients (28.5%). Cardiac arrest was present at admission in 13 patients (8.4%). Intra-aortic balloon pump was inserted in 16 patients (10.4%). In patients with malignancy, higher B-type natriuretic peptide (BNP), leukocyte and C-reactive protein (CRP) peaks could be observed during the hospital phase. Initial impairment of left ventricular ejection fraction was negatively related to BNP, leukocyte, and CRP peaks. At a median follow-up of 364 days, all-cause death occurred in 41 patients (26.6%) and cardiac death in 12 patients (7.7%). Multivariate Cox regression analysis identified malignancy (hazard ratio 4.77 (1.02-22.17), leukocyte peak and age as independent predictors of cardiac death. Malignancy (2.62 (1.26-5.44), leukocyte peak (1.05 (1.01-1.08) and initial cardiac arrest (6.68 (2.47-18.01) were identified as independent predictors of overall mortality. CONCLUSIONS: In the present takotsubo patients, the prevalence of malignancy was high and may have affected cardiovascular outcomes through the activation of inflammatory and neurohormonal mechanisms. (Circ J 2016; 80: 2192-2198).
Girardey et al. (2016) conducted a cohort in Takotsubo cardiomyopathy (n=154). History of malignancy vs. No history of malignancy was evaluated on All-cause mortality (HR 2.62, 95% CI 1.26-5.44, p=0.010). A history of malignancy in patients with takotsubo cardiomyopathy was associated with a significantly higher risk of overall mortality (HR 2.62) compared to patients without a history of malignancy.