Prediction of short‐ and long‐term mortality in takotsubo syndrome: the InterTAK Prognostic Score

Wischnewsky, Manfred; Candreva, Alessandro; Bacchi, Beatrice; Cammann, Victoria L.; Kato, Ken; Szawan, Konrad A.; Gili, Sebastiano; D’Ascenzo, Fabrizio; Dichtl, Wolfgang; Citro, Rodolfo; Bossone, Eduardo; Neuhaus, Michael; Franke, Jennifer; Sorici-Barb, Ioana; Jaguszewski, Miłosz; Noutsias, Michel; Knorr, Maike; Heiner, Susanne; Burgdorf, Christof; Kherad, Behrouz; Tschöpe, Carsten; Sarcon, Annahita; Shinbane, Jerold S.; Rajan, Lawrence; Michels, Guido; Pfister, Roman; Cuneo, Alessandro; Jacobshagen, Claudius; Karakas, Mahir; Köenig, Wolfgang; Pott, Alexander; Meyer, Philippe; Arroja, José David; Banning, Adrian P.; Cuculi, Florim; Kobza, Richard; Fischer, Thomas; Vasankari, Tuija; Airaksinen, Juhani; Napp, L. Christian; Budnik, Monika; Dworakowski, Rafał; MacCarthy, Philip; Kaiser, Christoph; Oßwald, Stefan; Galiuto, Leonarda; Chan, Christina; Bridgman, Paul; Beug, Daniel; Delmas, Clément; Lairez, Olivier; El‐Battrawy, Ibrahim; Akın, İbrahim; Gilyarova, Ekaterina; Shilova, Alexandra; Gilyarov, Mikhail; Kozel, Martin; Toušek, Petr; Winchester, David E.; Gałuszka, Jan; Ukena, Christian; Poglajen, Gregor; Carrilho‐Ferreira, Pedro; Hauck, Christian; Paolini, Carla; Bilato, Claudio; Prasad, Abhiram; Rihal, Charanjit S.; Liu, Kan; Schulze, P. Christian; Bianco, Matteo; Jörg, Lucas; Rickli, Hans; Nguyen, Thanh Ha; Kobayashi, Yoshio; Böhm, Michael; Maier, Lars S.; Pinto, Fausto J.; Widimský, Petr; Borggrefe, Martin; Felix, Stephan B.; Opolski, Grzegorz; Braun‐Dullaeus, Ruediger C.; Rottbauer, Wolfgang; Hasenfuß, Gerd; Pieske, Burkert; Schunkert, Heribert; Thiele, Holger; Bauersachs, Johann; Katus, Hugo A.; Horowitz, John D.; Mario, Carlo Di; Münzel, Thomas; Crea, Filippo; Bax, Jeroen J.; Lüscher, Thomas F.; Ruschitzka, Frank; Ghadri, Jelena R.; Templin, Christian

doi:10.1002/ejhf.1561

Cited by 23 publications

(23 citation statements)

References 7 publications

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“…Indeed, the available data (see Table 1) suggest that hemodynamic impact might have been greater in A/Ca patients, but this was not studied in detail. A recent analysis from the InterTAK group [19] also demonstrated that clinical factors associated with haemodynamic impact of TTS attacks, including hypotension, tachycardia and reduced left ventricular ejection fraction, all function as adverse long-term prognostic markers. Other recent publications [20,21] also documented that patients with A/Ca had poor in-hospital outcomes.…”

Section: Discussionmentioning

confidence: 99%

Antecedent cancer in Takotsubo syndrome predicts both cardiovascular and long-term mortality

et al. 2019

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Background: Takotsubo syndrome (TTS), primarily an acute myocardial inflammatory condition engendered by catecholamine exposure, is associated with similar long-term mortality rates to those of patients with acute myocardial infarction. However, there is increasing evidence of a nexus between TTS and underlying malignancies:many patients have antecedent cancer (A/Ca), while incremental risk of late cancer-related death has also been reported. Purpose: To evaluate potential interactions between A/Ca among TTS patients and both early and late clinical course.Methods: Three hundred forty-six consecutive TTS patients [aged 69 ± 13 (SD) years, males: 8.2%] were prospectively followed up for a median duration of 4.1 (IQR 2.2-6.4) years. Associations between A/Ca and severity of acute attacks, in-hospital complications and long-term death rates were sought utilising univariate analyses followed by multiple logistic regression analysis. Results: A/Ca (present in 16.8% of patients) was associated with (i) greater elevation of hs-CRP and NT-proBNP concentrations (p = 0.01 and 0.04, respectively), (ii) more complicated in-hospital clinical course, with major adverse cardiac events (MACE) in 30.9% of patients, compared to 18.2% in non-A/Ca patients (p = 0.04). Long-term all-cause mortality rate was also greater [hazard ratio (HR) = 2.4, p = 0.0001] in A/Ca patients, with an excess cardiovascular (CVS) fatality rate (HR = 3.1, p = 0.001). On multivariate analysis, male gender, peak plasma concentrations of normetanephrine and hs-CRP, early arrhythmias and development of shock, but not A/Ca per se, were all independently associated with increased long-term mortality rate. Furthermore, patients discharged on β-adrenoceptor antagonists (βBl) or angiotensin converting enzyme inhibitors/ angiotensin receptor blockers (ACEi/ARB) had lower long-term mortality rates (β = − 0.2, p = 0.01; β = − 0.14, p = 0.05, respectively). Conclusions: (1) A/Ca is associated with greater clinical severity of initial TTS attacks and substantially greater longterm CVS-related as well as all-cause mortality.(2) Post-discharge therapy with either βBl or ACEi/ARB is associated with reductions in long-term mortality rates. Overall, the current data suggest operation of substantial interactions between neoplasia and TTS, both at the level of pathogenesis and of outcomes.

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Section: Discussionmentioning

confidence: 99%

Antecedent cancer in Takotsubo syndrome predicts both cardiovascular and long-term mortality

et al. 2019

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“…Mortality is doubled for patients with physical triggers compared to patients with ACS [ 59 ]. The InterTAK Prognostic Score was established for risk prediction and incorporates covariates strongly associated with prognosis such as demographics, triggering factors, hemodynamics, and comorbidities [ 68 ].…”

Section: Prognosismentioning

confidence: 99%

Takotsubo Syndrome: Uncovering Myths and Misconceptions

Cammann

Würdinger

Ghadri

et al. 2021

Curr Atheroscler Rep

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Purpose of Review Takotsubo syndrome (TTS) was described in Japan 3 decades ago to affect predominately postmenopausal women after emotional stress. This history is the basis of commonly held beliefs which may contribute to the underdiagnosis and misperception of TTS. Recent Findings TTS affects not only women, but can be present in both sexes, and can appear in children as well as in the elderly. TTS is characterized by unique clinical characteristics with morphological variants, and incurs a substantial risk for recurrent events and adverse outcomes. Physical triggers are more common than emotional triggers and are major disease determinants. TTS seems not to be completely transient as patients report ongoing chest pain, dyspnea, or fatigue even after months of the acute event. Summary Knowledge of the clinical features and outcomes of TTS patients has evolved substantially over the past decades. The heterogeneous appearance of TTS needs to be recognized in all medical disciplines to maximize therapy and improve outcomes.

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“…The chest pain was located in the substernal area, characterized by a squeezing pattern and relieved after approximately 30 min before coronary angiography (CAG) was performed. The InterTAK diagnostic score was 18 [ 5 ], and the prognostic score was 12 [ 6 ]. An emergency CAG was performed that showed no significant atherosclerotic lesions (Fig.…”

Section: Case Presentationmentioning

confidence: 99%

Alternate recurrent coronary artery spasm and stress cardiomyopathy: a case report

Jin

Guo

2020

BMC Cardiovasc Disord

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Background Coronary artery spasm (CAS) and stress cardiomyopathy (SC) have different characteristic clinical manifestations in the case of suspicious myocardial infarction with nonobstructive coronary arteries. Established recurrence rates of both conditions have been reported, however, alternate recurrent CAS and SC in the same individual have not been described. Case presentation A 59-year-old man suffered from atypical chest pain in the first episode, acute heart attack in the second and third episodes (totally 3 times over a period of approximately 5 years). During the first episode, he visited our hospital with mild paroxysmal chest pain without obvious inducement for approximately 2 years. He was underdiagnosed at that time without other obvious findings except the poor R wave progression in V1–3 leads revealed in electrocardiogram. At 4 months after the first episode, he suffered from a heart attack (the second episode) and was diagnosed with SC based on the coronary angiography (CAG) and left ventriculography findings of nonobstructive coronary arteries combined with a classic apical ballooning shape. At 31 months after the second episode, he suffered another heart attack (the third episode) and was diagnosed with CAS based on the CAG results of recoverable severe multivessel stenoses. During the episodes, partial reversible nature of apical hypokinesis was observed in echocardiogram. In retrospect, the patient suffered silent CAS in the first episode, SC in the second episode, and severe multivessel CAS in the third episode. Conclusion The unusual presentations observed in this case have not been reported. This case suggests that cardiologists should be aware of the possibility of alternate recurrent CAS and SC in the same individual. Provocative tests for spasm and cardiac magnetic resonance imaging might help gain more insights into this issue.

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Prediction of short‐ and long‐term mortality in takotsubo syndrome: the InterTAK Prognostic Score

Cited by 23 publications

References 7 publications

Antecedent cancer in Takotsubo syndrome predicts both cardiovascular and long-term mortality

Antecedent cancer in Takotsubo syndrome predicts both cardiovascular and long-term mortality

Takotsubo Syndrome: Uncovering Myths and Misconceptions

Alternate recurrent coronary artery spasm and stress cardiomyopathy: a case report

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