Clinical correlates and prognostic impact of neurologic disorders in Takotsubo syndrome
Authors: Cammann Victoria L. , Scheitz Jan F. , von Rennenberg Regina , Jäncke Lutz , Nolte Christian H. , Szawan Konrad A. , Stengl Helena , Würdinger Michael , Endres Matthias , Templin Christian , Ghadri Jelena R. ,   InterTAK Consortium, Citro Rodolfo , Vecchione Carmine , Bossone Eduardo , Gili Sebastiano , Neuhaus Michael , Franke Jennifer , Meder Benjamin , Jaguszewski Miłosz , Noutsias Michel , Knorr Maike , Jansen Thomas , D’Ascenzo Fabrizio , Dichtl Wolfgang , Burgdorf Christof , Kherad Behrouz , Tschöpe Carsten , Sarcon Annahita , Shinbane Jerold , Rajan Lawrence , Michels Guido , Pfister Roman , Cuneo Alessandro , Jacobshagen Claudius , Karakas Mahir , Koenig Wolfgang , Pott Alexander , Meyer Philippe , Roffi Marco , Banning Adrian , Wolfrum Mathias , Cuculi Florim , Kobza Richard , Fischer Thomas A. , Vasankari Tuija , Airaksinen K. E. Juhani , Napp L. Christian , Dworakowski Rafal , MacCarthy Philip , Kaiser Christoph , Osswald Stefan , Galiuto Leonarda , Chan Christina , Bridgman Paul , Beug Daniel , Delmas Clément , Lairez Olivier , Gilyarova Ekaterina , Shilova Alexandra , Gilyarov Mikhail , El-Battrawy Ibrahim , Akin Ibrahim , Poledniková Karolina , Toušek Petr , Winchester David E. , Galuszka Jan , Ukena Christian , Poglajen Gregor , Carrilho-Ferreira Pedro , Hauck Christian , Paolini Carla , Bilato Claudio , Kobayashi Yoshio , Kato Ken , Shoji Toshihiro , Ishibashi Iwao , Takahara Masayuki , Himi Toshiharu , Din Jehangir , Al-Shammari Ali , Prasad Abhiram , Rihal Charanjit S. , Liu Kan , Schulze P. Christian , Bianco Matteo , Jörg Lucas , Rickli Hans , Pestana Gonçalo , Nguyen Thanh H. , Böhm Michael , Maier Lars S. , Pinto Fausto J. , Widimský Petr , Felix Stephan B. , Braun-Dullaeus Ruediger C. , Rottbauer Wolfgang , Hasenfuß Gerd , Pieske Burkert M. , Schunkert Heribert , Budnik Monika , Opolski Grzegorz , Borggrefe Martin , Thiele Holger , Bauersachs Johann , Katus Hugo A. , Horowitz John D. , Di Mario Carlo , Münzel Thomas , Crea Filippo , Bax Jeroen J. , Scherff Frank , Niederseer David , Lüscher Thomas F. 
Published: December 2021

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.