Exploring the influence of takotsubo syndrome on oncologic patients’ mortality

Abstract

It has been reported that patients affected by takotsubo syndrome (TTS) with a concurrent diagnosis of cancer suffer from greater mortality as compared to their non-cancer counterpart. It remains unclear whether TTS worsens the prognosis of cancer patients as well. Aim of this study was to compare outcomes of cancer patients with and without TTS. We combined data from two independent cohorts: one consisted of a prospective multicentre TTS registry; the second cohort consisted of all oncologic patients from two Cardio-Oncology Outpatient Clinics, who did not have cardiovascular conditions at the time of the cardio-oncologic visit. From the TTS registry, we selected patients with cancer (cancer-TTS patients). Next, we matched these patients with those from the cardio-oncologic cohort (cancer non-TTS patients) in a 1:2 fashion by age, sex, and type and cancer staging. Study endpoint was all-cause mortality. Among 318 TTS patients, 42 (13%) had a concurrent diagnosis of cancer. Characteristics of cancer-TTS patients and of the 84 matched cancer non-TTS subjects were comparable with the exception of diabetes mellitus, which was more common in cancer non-TTS patients. All-cause mortality was similar between cancer-TTS and cancer non-TTS patients. At Cox regression analysis TTS was not associated with mortality (OR 1.4, 95% CI 0.6–3.3, p = 0.43). Our findings show that even in the presence of acute heart failure due to TTS, the prognosis of oncologic patients is driven by the malignancy itself. Our results may prove useful for integrated management of cardio-oncologic patients.

A contemporary update on cancer and takotsubo syndrome

“…In this era of precision medicine, during which great improvements in CV and oncologic treatments and better prognosis have been recorded, an integrated approach caring for patients’ bidirectional needs appears fundamental ( 24 , 25 ). In the case of a comorbid HF and oncologic patient, as each disease influences the management of the other, cooperation of clinicians must be pursued.…”

“…Moreover, it has been reported that cancer patients are frequently under-treated in the CV setting ( 21 , 25 , 52 – 54 ). On the other hand, from an oncologic perspective, chronic CV comorbidities or acute events (as TTS) may be perceived as debilitating when pertaining a cancer patient, possibly impacting delivery of optimal treatments ( 22 , 24 , 50 ). This latter aspect may be alarming when one considers how mortality in TTS is typically comorbidity-related (i.e., cancer-related), and thus it might be enhanced by an oncologic undertreatment due to the acute CV event.…”

“…This latter aspect may be alarming when one considers how mortality in TTS is typically comorbidity-related (i.e., cancer-related), and thus it might be enhanced by an oncologic undertreatment due to the acute CV event. Nonetheless, the only analysis to date, though from a small cohort, comparing TTS patients with cancer to a non-TTS matched cancer counterpart, showed similar prognosis in the two groups, suggesting that mortality is unrelated to the TTS event ( 24 ).…”

“…This is very important in Cardio-Oncology, where specific CV comorbidities may significantly influence the oncologic management. In a certain way, after the acute TTS phase, the cardiologic perspective should be of reassurance and cooperation toward the oncologist and the oncologic management ( 24 ).…”