Takotsubo Syndrome Recurrence: A Trigger for Increased 30-Day Cardiovascular Mortality

OBJECTIVES: Recurrence of Takotsubo syndrome (TTS) has been reported with a rate up to 4%. The effect of TTS recurrence on clinical outcomes has not been in the focus of studies so far. METHODS: In our study, we enrolled 435 patients with TTS, of whom 14 patients had a recurrence. The inclusion interval for the index event was from 2015 to 2022, and patients were followed to categorize them in the group of TTS with or without the recurrence. TTS recurrences were registered until June 2024. Blood samples, data on clinical presentation, precipitating factors, cardiovascular risk factors, medications, demographics, echocardiographic and electrocardiographic parameters were obtained. The 30-day cardiovascular mortality (CV), the 30-day mortality, and arrhythmia during hospitalization were evaluated. RESULTS: Comorbidities, ECG changes, premedication, and symptoms were not significantly different between TTS patients with and without recurrence. Only the index left ventricular ejection fraction (LVEF) of TTS patients with recurrence was significantly decreased (p = 0.046). In the case of outcome parameters, TTS patients with recurrence had a significantly, higher 30-day CV mortality compared to those without recurrence (21.4% vs. 3.8%, p = 0.001) with a 5.9-fold higher 30-day CV mortality (B(SE) = 1.94 (0.70), p = 0.001). CONCLUSION: In our study, the TTS recurrence was associated with 5.9-fold higher 30-day CV mortality. Therefore, a more precise monitoring is necessary in this high-risk group. Whether only the reduced LVEF is responsible for the increased 30-day CV mortality is an open issue and more factors can be assumed to play a role.