Factors Associated with Recurrence in Takotsubo Syndrome: A Systematic Review

Campos, Felipe Alverenga Duarte; Ritt, Luiz Eduardo Fonteles; Costa, João Paulo Soares; Cruz, Constança Margarida; Feitosa-Filho, Gilson Soares; Oliveira, Queila Borges de; Darzé, Eduardo Sahade

doi:10.36660/abc.20180377

home Sumário navigate_before Anterior Atual Seguinte navigate_next

home Sumário

Original Article • Arq. Bras. Cardiol. 114 (3) • Mar 2020 • https://doi.org/10.36660/abc.20180377 linkcopy

Factors Associated with Recurrence in Takotsubo Syndrome: A Systematic Review

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Background: Takotsubo syndrome (TTS) is characterized by a temporary systolic dysfunction of the left ventricle (LV) related to a stressful event. However, the factors associated with its recurrence are still not well established.

Objective: To analyze the main factors associated with TTS recurrence.

Methods: A systematic review was performed using the PRISMA model. Observational studies, published between January 2008 and October 2017, which presented a recurrence rate of at least 3% and/or 5 or more patients with recurrence, and who met at least 80% of the STROBE criteria were included.

Results: six articles reached the criteria to compose this systematic review. The recurrence rate ranged from 1 to 3.5% per year (global recurrence rate 3.8%). One study associated higher recurrence rate with the female gender, four reported the time between the first and second episodes, one study associated body mass index (BMI) and hypercontractility of the LV middle anterior wall to a higher recurrence rate. No association between recurrence and electrocardiographic changes were determined. Beta-blockers use was not associated with recurrence rates.

Conclusions: Female gender, time from the first episode of the syndrome, low BMI and midventricular obstruction were reported as potential predictors of TTS recurrence.

Keywords:
Takotsubo Syndrome; Takotsubo cardiomyopathy; Recurrence

Reference	Study design	Publishing journal	Points on STROBE	%
Looi et al.,⁹	Prospective cohort.	Journal of Heart, Lung and Circulation.	18	81.8
Templin et al.,³	Case-control.	The New England Journal of Medicine.	19	86.3
Patel et al.,¹⁰	Retrospective cohort.	Journal of Cardiac Failure.	19	86.3
Elesber et al.,¹¹	Retrospective cohort.	Journal of the American College of Cardiology.	19	86.3
Vriz et al.,¹²	Prospective cohort.	Journal of Cardiovascular Medicine.	18	81.8
Nishida et al.,¹³	Case-control.	Heart and Vessels.	20	90.9

Reference	Studied population	Level of Significance adopted	Recurrence rate(recurrence N/total N)	Analyzed data with possible recurrence association
Looi et al.,⁹	Patients admitted to Middlemore Hospital, Auckland City Hospital and North Shore Hospital, Auckland, New Zealand.	p < 0.05	7% (7/100)	- Time between manifestations: recurrences occurred from 99 to 679 days after the first episode, being more frequent in the first year. - Triggering factor: 57% of patients with recurrence presented emotional stress as a trigger. - Clinical characteristics: recurrence in patients presenting ST elevation was not higher when compared to patients who did not present ST elevation (7.4 and 6.3%, respectively); p = 1.00. - Medications in use: 4 (57%) of the patients used BB on recurrence.
Templin et al., ³	Patients obtained through the Mayo Clinic database. Patients with ACS from Zurich Acute Coronary Syndrome Registry.	p < 0.05	3.26% (57/1750)	- Time between manifestations: recurrence occurred from 25 days to 9.2 years after the first episode. - Medications in use: 29 patients (50.8%) used BB during the second episode.
Patel et al., ¹⁰	Patients obtained through the Mayo Clinic database.	p < 0.05 for men versus women p < 0.25 for comparison with women ≥ 50 years of age (due to multiple comparisons)	3.13% (7/224)	- Gender: there were no recurrences in men and all 7 recurrences were in women (14.8%) - Age: recurrence in women aged < 50 years was more prevalent in relation to recurrence in women aged ≥ 50 years (16 and 3%, respectively; p = 0.017).
Elesber et al., ¹¹	Patients diagnosed with TTS submitted to the Mayo Clinic catheterization center database.	p < 0.05	11.4% (10/100)	- Time between manifestations: 4.4±4.6 mean years between episodes, with a higher recurrence rate in the first 4 years compared to subsequent years (2.9 and 1.3% a year, respectively). - Medications in use: recurrence in patients in use X without use of: aspirin (60x67%), p = 0.67; ACEI/ARB (60x51%), p = 0.59; BB (80x52%), p = 0.10; Statins (40x33%), p = 0.67.
Vriz et al.,¹²	Patients at San Antonio Community Hospital (San Daniele del Friuli, Udine, Italy).	p < 0.05	21.7% (5/23)	- Age: more frequent in older patients. - Time between manifestations: recurrence occurred on an average of 105.4 ± 82.92 days after the first episode, being more frequent in the first 3 months. - Clinical characteristics: more frequent recurrence in patients with lower LVEF, lower SBP and higher troponin peak. - Medications in use: therapy with BB did not prevent recurrence.
Nishida et al.,¹³	Patients from the BOREAS Registry database.	p < 0.05	2.8% (7/251)	-Clinical characteristics: low BMI, medium-ventricular hypercontractility and right ventricular involvement were both associated with a higher rate of recurrence of TTS (p = 0.048, 0.01, and 0.06, respectively). HRs of recurrence for BMI (per increase by 1 kg/cm²) and MVO were 0.75 (95% CI 0.54-0.99) and 14.71 (95% CI 1.87-304.66), respectively.

vertical_align_top show_chart

more_horiz close
- image
- translate
- link
- article
- vertical_align_top
- file_download
- show_chart
- image
- translate
- link
- article

location_on

Sociedade Brasileira de Cardiologia - SBC Avenida Marechal Câmara, 160, sala: 330, Centro, CEP: 20020-907, (21) 3478-2700 - Rio de Janeiro - RJ - Brazil, Fax: +55 21 3478-2770 - São Paulo - SP - Brazil
E-mail: revista@cardiol.br

rss_feed Acompanhe os números deste periódico no seu leitor de RSS

[TFN1] BB: beta-blocker; ACS: acute coronary syndrome; TTS: Takotsubo syndrome; ACEI: angiotensin converting enzyme inhibitor; ARB: angiotensin II receptor blocker; LVEF: left ventricle ejection fraction; SBP: systolic blood pressure; BMI: Body Mass Index; HRs: hazard ratios; CI: confidence interval; MVO: microvascular obstruction.