Key result
Patients with COVID-19 who developed takotsubo syndrome had a significantly higher mortality rate (26.0%) compared to those with other acute respiratory diseases (5.7%) or no respiratory disease (4.2%; p<0.001).
Why the study?
Respiratory conditions trigger takotsubo syndrome and portend worse outcomes, but data on takotsubo syndrome in patients with COVID-19 infection are limited.
Does COVID-19 infection alter the clinical presentation and mortality of Takotsubo syndrome compared to other triggers?
Systematic Review
Does COVID-19 infection alter the clinical presentation and mortality of Takotsubo syndrome compared to other triggers?
Absolute Event Rate: 26% vs 5.7%
p-value: p=<0.001
COVID-19-triggered Takotsubo syndrome is associated with atypical presentations and significantly higher mortality compared to TTS triggered by other respiratory or non-respiratory conditions.
TTS with COVID-19 shows markedly higher mortality than other respiratory triggers; leaves open whether unique mechanisms or biases explain outcomes in this case series.
Background Respiratory conditions are major physical triggers of takotsubo syndrome (TTS) and portend worse outcomes. However, data on TTS in patients with coronavirus disease-2019 infection (COVID-19) are limited. Methods We searched PubMed, EMBASE, and Cochrane Library databases for case reports from 2019-2022 describing TTS in patients with COVID-19 pneumonia. We summarized the clinical data and outcomes and compared them to those in patients with TTS-acute respiratory disease (other than COVID) and those with TTS-no respiratory disease. Results The mortality rate was higher in TTS-COVID (26.0%) than in TTS-acute respiratory disease (5.7%) and TTS-no respiratory disease (4.2%; p<0.001 for both). The proportion of men was higher in TTS-COVID (33.3%) than in TTS-no respiratory disease (9.1%; p<0.001). The manifestations of TTS in COVID patients were atypical (dyspnea [70.3%] and cough [40.6%]); few had chest pain (23.4%). Cardiovascular risk factors were common in the TTS-COVID cohort, but fewer patients were on cardioprotective medications than in the other two groups. Catecholamine use was higher in the TTS-COVID group (37.7%) than in TTS-no respiratory disease (10.9%, p<0.001) groups. Apical ballooning (72.6%) was the most common TTS subtype, and basal segment type was seen in 11.0% of TTS-COVID patients. Conclusions COVID-19 patients who developed TTS had high mortality rates and unique features as compared with those in the TTS-acute respiratory disease or TTS-no respiratory disease groups. Understanding the pathophysiology of TTS in COVID-19 may help prevent TTS and direct therapy in this setting.
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Lu et al. (2024) conducted a systematic review in Takotsubo Syndrome in patients with COVID-19. COVID-19 pneumonia vs. TTS-acute respiratory disease (other than COVID) and TTS-no respiratory disease was evaluated on Mortality rate (p=<0.001). Patients with COVID-19 who developed takotsubo syndrome had a significantly higher mortality rate (26.0%) compared to those with other acute respiratory diseases (5.7%) or no respiratory disease (4.2%; p<0.001).
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