Prognostic impact of acute pulmonary triggers in patients with takotsubo syndrome: new insights from the International Takotsubo Registry
Authors: Kato Ken , Cammann Victoria L. , Napp L. Christian , Szawan Konrad A. , Micek Jozef , Dreiding Sara , Levinson Rena A. , Petkova Vanya , Würdinger Michael , Patrascu Alexandru , Sumalinog Rafael , Gili Sebastiano , Clarenbach Christian F. , Kohler Malcolm , Wischnewsky Manfred , Citro Rodolfo , Vecchione Carmine , Bossone Eduardo , Neuhaus Michael , Franke Jennifer , Meder Benjamin , Jaguszewski Milosz , Noutsias Michel , Knorr Maike , Heiner Susanne , 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 , Budnik Monika , 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 , Kozel Martin , Tousek Petr , Winchester David E. , Galuszka Jan , Ukena Christian , Poglajen Gregor , Carrilho‐Ferreira Pedro , Hauck Christian , Paolini Carla , Bilato Claudio , Sano Masanori , Ishibashi Iwao , Takahara Masayuki , Himi Toshiharu , Kobayashi Yoshio , 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. , Opolski Grzegorz , Braun‐Dullaeus Ruediger C. , Rottbauer Wolfgang , Hasenfuß Gerd , Pieske Burkert M. , Schunkert Heribert , Borggrefe Martin , Thiele Holger , Bauersachs Johann , Katus Hugo A. , Horowitz John D. , Di Mario Carlo , Münzel Thomas , Crea Filippo , Bax Jeroen J. , Lüscher Thomas F. , Ruschitzka Frank , Ghadri Jelena R. , Templin Christian 
Published: March 2021

Aims

Acute pulmonary disorders are known physical triggers of takotsubo syndrome (TTS). This study aimed to investigate prevalence of acute pulmonary triggers in patients with TTS and their impact on outcomes.

Methods and results

Patients with TTS were enrolled from the International Takotsubo Registry and screened for triggering factors and comorbidities. Patients were categorized into three groups (acute pulmonary trigger, chronic lung disease, and no lung disease) to compare clinical characteristics and outcomes.

Of the 1670 included patients with TTS, 123 (7%) were identified with an acute pulmonary trigger, and 194 (12%) had a known history of chronic lung disease. The incidence of cardiogenic shock was highest in patients with an acute pulmonary trigger compared with those with chronic lung disease or without lung disease (17% vs. 10% vs. 9%, P = 0.017). In‐hospital mortality was also higher in patients with an acute pulmonary trigger than in the other two groups, although not significantly (5.7% vs. 1.5% vs. 4.2%, P = 0.13). Survival analysis demonstrated that patients with an acute pulmonary trigger had the worst long‐term outcome (P = 0.002). The presence of an acute pulmonary trigger was independently associated with worse long‐term mortality (hazard ratio 2.12, 95% confidence interval 1.33–3.38; P = 0.002).

Conclusions

The present study demonstrates that TTS is related to acute pulmonary triggers in 7% of all TTS patients, which accounts for 21% of patients with physical triggers. The presence of acute pulmonary trigger is associated with a severe in‐hospital course and a worse long‐term outcome.