Cardiac troponin elevation and mortality in takotsubo syndrome: New insights from the international takotsubo registry
Authors: Stähli Barbara E. , Schindler Matthias , Schweiger Victor , Cammann Victoria L. , Szawan Konrad A. , Niederseer David , Würdinger Michael , Schönberger Alexander , Schönberger Maximilian , Koleva Iva , Mercier Julien C. , Petkova Vanya , Mayer Silvia , 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 , von Lewinski Dirk , 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. , Massoomi Michael , Galuszka Jan , Ukena Christian , Poglajen Gregor , Carrilho‐Ferreira Pedro , Hauck Christian , Paolini Carla , Bilato Claudio , Kobayashi Yoshio , Kato Ken , Ishibashi Iwao , 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 , Thiele Holger , Bauersachs Johann , Horowitz John D. , Di Mario Carlo , Kong William , Dalakoti Mayank , Imori Yoichi , Liberale Luca , Montecucco Fabrizio , Münzel Thomas , Crea Filippo , Lüscher Thomas F. , Bax Jeroen J. , Ruschitzka Frank , Ghadri Jelena R. , Di Vece Davide , Templin Christian 
Published: October 2024

Background

The clinical relevance of cardiac troponin (cTn) elevation in takotsubo syndrome (TTS) remains uncertain. The present study sought to investigate the role of cardiac troponin (cTn) elevations in mortality prediction of patients with Takotsubo syndrome (TTS).

Methods

Patients enrolled in the International Takotsubo (InterTAK) Registry from January 2011 to February 2020 with available data on peak cTn levels were included in the analysis. Peak cTn levels during the index hospitalization were used to define clinically relevant myocardial injury. The threshold at which clinically relevant myocardial injury drives mortality at 1 year was identified using restricted cubic spline analysis.

Results

Out of 2′938 patients, 222 (7.6%) patients died during 1‐year follow‐up. A more than 28.8‐fold increase of cTn above the upper reference limit was identified as threshold for clinically relevant myocardial injury. The presence of clinically relevant myocardial injury was significantly associated with an increased risk of mortality at 5 years (adjusted HR 1.58, 95% CI 1.18–2.12, p =.002). Clinically relevant myocardial injury was related to an increased 5‐year mortality risk in patients with apical TTS (adjusted HR 1.57, 95% CI 1.21–2.03, p =.001), in presence of physical stressors (adjusted HR 1.60, 95% CI 1.22–2.11, p =.001), and in absence of emotional stressors (adjusted HR 1.49, 95% CI, 1.17–1.89, p =.001).

Conclusion

This study for the first time determined a troponin threshold for the identification of TTS patients at excess risk of mortality. These findings advance risk stratification in TTS and assist in identifying patients in need for close monitoring and follow‐up.