Takotsubo Cardiomyopathy Outcomes Should Be Stratified Based on the Triggering Etiology

Comparison of mortality in primary and secondary Takotsubo cardiomyopathy with severe left ventricular dysfunction

“…Analysis of the previous registries such as RETAKO (Spanish National REgistry for TAKOtsubo cardiomyopathy) have demonstrated a significantly higher rate of morbidity and mortality in patients with secondary TC compared to primary forms, who otherwise had comparable demographic, functional and cardiovascular risk profiles . Similarly, secondary form TC patients had higher rates of cardiogenic shock, peak cardiac enzymes, increased use of inotropes, mechanical ventilator requirement, increased future recurrence and also higher readmission rates due to cardiovascular events . Even in the current study by Citro et al ., Table 1 describes a higher rate of secondary/physical TC compared to primary/emotional TC in patients with LVEF < 35%, however a direct mortality and MACE comparison between primary and secondary forms of TC in patients with LVEF ≤ 35% is lacking.…”

“…2 -4 We have also previously emphasized that primary TC, in comparison to secondary TC, generally has a relatively benign spectrum and a good overall prognosis, unless complicated by cardiogenic shock. 3 registries such as RETAKO (Spanish National REgistry for TAKOtsubo cardiomyopathy) have demonstrated a significantly higher rate of morbidity and mortality in patients with secondary TC compared to primary forms, who otherwise had comparable demographic, functional and cardiovascular risk profiles. 2 Similarly, secondary form TC patients had higher rates of cardiogenic shock, peak cardiac enzymes, increased use of inotropes, mechanical ventilator requirement, increased future recurrence and also higher readmission rates due to cardiovascular events.…”

“…In addition to the comparison of mortality based upon LVEF alone, it would be of great value to analyse the mortality data between the patients of primary vs. secondary forms of TC. Primary TC occurs in the setting of either psychic or emotional stimuli or without clear identifiable triggers (idiopathic), whereas secondary TC is triggered by physical stressors such as intracranial haemorrhage or cerebrovascular accident, trauma, sepsis, surgery, or other critical illnesses . It is now well known that secondary forms of TC are usually associated with much worse short‐ and long‐term prognoses .…”

“…Primary TC occurs in the setting of either psychic or emotional stimuli or without clear identifiable triggers (idiopathic), whereas secondary TC is triggered by physical stressors such as intracranial haemorrhage or cerebrovascular accident, trauma, sepsis, surgery, or other critical illnesses . It is now well known that secondary forms of TC are usually associated with much worse short‐ and long‐term prognoses . We have also previously emphasized that primary TC, in comparison to secondary TC, generally has a relatively benign spectrum and a good overall prognosis, unless complicated by cardiogenic shock .…”

“…It is now well known that secondary forms of TC are usually associated with much worse short‐ and long‐term prognoses . We have also previously emphasized that primary TC, in comparison to secondary TC, generally has a relatively benign spectrum and a good overall prognosis, unless complicated by cardiogenic shock . Analysis of the previous registries such as RETAKO (Spanish National REgistry for TAKOtsubo cardiomyopathy) have demonstrated a significantly higher rate of morbidity and mortality in patients with secondary TC compared to primary forms, who otherwise had comparable demographic, functional and cardiovascular risk profiles .…”