Clinical Features and Outcomes of Patients With Malignancy and Takotsubo Syndrome: Observations From the International Takotsubo Registry
Authors: Cammann Victoria L. , Sarcon Annahita , Ding Katharina J. , Seifert Burkhardt , Kato Ken , Di Vece Davide , Szawan Konrad A. , Gili Sebastiano , Jurisic Stjepan , Bacchi Beatrice , Micek Jozef , Frangieh Antonio H. , Napp L. Christian , Jaguszewski Milosz , Bossone Eduardo , Citro Rodolfo , D'Ascenzo Fabrizio , Franke Jennifer , Noutsias Michel , Knorr Maike , Heiner Susanne , Burgdorf Christof , Koenig Wolfgang , Thiele Holger , Tschöpe Carsten , Rajan Lawrence , Michels Guido , Pfister Roman , Cuneo Alessandro , Jacobshagen Claudius , Karakas Mahir , Banning Adrian , Cuculi Florim , Kobza Richard , Fischer Thomas A. , Vasankari Tuija , Airaksinen K. E. Juhani , Dworakowski Rafal , Kaiser Christoph , Osswald Stefan , Galiuto Leonarda , Dichtl Wolfgang , Delmas Clément , Lairez Olivier , Horowitz John D. , Kozel Martin , Widimský Petr , Tousek Petr , Winchester David E. , Gilyarova Ekaterina , Shilova Alexandra , Gilyarov Mikhail , El‐Battrawy Ibrahim , Akin Ibrahim , Ukena Christian , Bauersachs Johann , Pieske Burkert M. , Hasenfuß Gerd , Rottbauer Wolfgang , Braun‐Dullaeus Ruediger C. , Opolski Grzegorz , MacCarthy Philip , Felix Stephan B. , Borggrefe Martin , Di Mario Carlo , Crea Filippo , Katus Hugo A. , Schunkert Heribert , Münzel Thomas , Böhm Michael , Bax Jeroen J. , Prasad Abhiram , Shinbane Jerold , Lüscher Thomas F. , Ruschitzka Frank , Ghadri Jelena R. , Templin Christian 
Published: July 2019

Background

Clinical characteristics and outcomes of takotsubo syndrome (
TTS
) patients with malignancy have not been fully elucidated. This study sought to explore differences in clinical characteristics and to investigate short‐ and long‐term outcomes in
TTS
patients with or without malignancy.

Methods and Results

TTS
patients were enrolled from the International Takotsubo Registry. The
TTS
cohort was divided into patients with and without malignancy to investigate differences in clinical characteristics and to assess short‐ and long‐term mortality. A subanalysis was performed comparing long‐term mortality between a subset of
TTS
patients with or without malignancy and acute coronary syndrome (ACS) patients with or without malignancy. Malignancy was observed in 16.6% of 1604
TTS
patients. Patients with malignancy were older and more likely to have physical triggers, but less likely to have emotional triggers compared with those without malignancy. Long‐term mortality was higher in patients with malignancy (
P
<0.001), while short‐term outcome was comparable (
P
=0.17). In a subanalysis, long‐term mortality was comparable between
TTS
patients with malignancies and ACS patients with malignancies (
P
=0.13). Malignancy emerged as an independent predictor of long‐term mortality.

Conclusions

A substantial number of
TTS
patients show an association with malignancy. History of malignancy might increase the risk for
TTS
, and therefore, appropriate screening for malignancy should be considered in these patients.

Clinical Trial Registration

URL
:
http://www.clinicaltrial.gov
. Unique identifier:
NCT
01947621.