Clinical correlates and prognostic impact of neurologic disorders in Takotsubo syndrome

Abstract

Cardiac alterations are frequently observed after acute neurological disorders. Takotsubo syndrome (TTS) represents an acute heart failure syndrome and is increasingly recognized as part of the spectrum of cardiac complications observed after neurological disorders. A systematic investigation of TTS patients with neurological disorders has not been conducted yet. The aim of the study was to expand insights regarding neurological disease entities triggering TTS and to investigate the clinical profile and outcomes of TTS patients after primary neurological disorders. The International Takotsubo Registry is an observational multicenter collaborative effort of 45 centers in 14 countries (ClinicalTrials.gov, identifier NCT01947621). All patients in the registry fulfilled International Takotsubo Diagnostic Criteria. For the present study, patients were included if complete information on acute neurological disorders were available. 2402 patients in whom complete information on acute neurological status were available were analyzed. In 161 patients (6.7%) an acute neurological disorder was identified as the preceding triggering factor. The most common neurological disorders were seizures, intracranial hemorrhage, and ischemic stroke. Time from neurological symptoms to TTS diagnosis was ≤ 2 days in 87.3% of cases. TTS patients with neurological disorders were younger, had a lower female predominance, fewer cardiac symptoms, lower left ventricular ejection fraction, and higher levels of cardiac biomarkers. TTS patients with neurological disorders had a 3.2-fold increased odds of in-hospital mortality compared to TTS patients without neurological disorders. In this large-scale study, 1 out of 15 TTS patients had an acute neurological condition as the underlying triggering factor. Our data emphasize that a wide spectrum of neurological diseases ranging from benign to life-threatening encompass TTS. The high rates of adverse events highlight the need for clinical awareness.

Clinical Characteristics And Outcomes Of Patients Hospitalised With Takotsubo Syndrome Triggered By Inflammatory Diseases

“…However, there were higher levels of NT-proBNP in patients with physical triggers than in patients with emotional triggers. Recently, Cammann et al showed that TTS patients with acute neurological disorders had the highest levels of markers indicative of myocardial injury [2]. Importantly, clinical manifestations differed among groups with different triggers.…”

“…Both physical and emotional stress have important roles as trigger mechanisms in Takotsubo syndrome (TTS). Acute neurological disease, malignancy, and trauma are major physical triggers with a negative impact on patient outcomes [1,2].…”

Limbic Responses to Aversive Visual Stimuli during the Acute and Recovery Phase of Takotsubo Syndrome

“…While around seven percent of TTS events are associated with clear neurologic triggers, such as seizures or intracranial bleeding [ 16 ], there is evolving evidence that the brain–heart axis is genuinely involved in the general pathogenesis of this condition, mainly involving the central autonomic nervous system (for review, see [ 17 , 18 ]). As no current TTS therapies exist, this underexplored field of neuro-cardiology might be of particular interest to develop new management approaches, including cognitive behavioral therapy and/or physical exercise training.…”

Epilepsy and Takotsubo cardiomyopathy: a scope review

“…On the other hand, one article, with 161 patients, showed that when associated with neurological disorders such as epilepsy, Takotsubo cardiomyopathy tends to be more common in young males 15 . Another study showed a previous convulsive history and alcoholism in most patients, and an association of convulsive epileptic status with poor medication compliance, alcohol abstinence, and stroke 13 .…”