Age-Related Variations in Takotsubo Syndrome

Cammann, V. L.; Szawan, K. A.; Stahli, B. E.; Kato, K.; Budnik, M.; Wischnewsky, M.; Dreiding, S.; Levinson, R. A.; Di Vece, D.; Gili, S.; Citro, R.; Bossone, E.; Neuhaus, M.; Franke, J.; Meder, B.; Jaguszewski, M.; Noutsias, M.; Knorr, M.; Heiner, S.; D'Ascenzo, F.; Dichtl, W.; Burgdorf, C.; Kherad, B.; Tschope, C.; Sarcon, A.; Shinbane, J.; Rajan, L.; Michels, G.; Pfister, R.; Cuneo, A.; Jacobshagen, C.; Karakas, M.; Koenig, W.; Pott, A.; Meyer, P.; Roffi, M.; Banning, A.; Wolfrum, M.; Cuculi, F.; Kobza, R.; Fischer, T. A.; Vasankari, T.; Airaksinen, K. E. J.; Napp, L. C.; Dworakowski, R.; Maccarthy, P.; Kaiser, C.; Osswald, S.; Galiuto, L.; Chan, C.; Bridgman, P.; Beug, D.; Delmas, C.; Lairez, O.; Gilyarova, E.; Shilova, A.; Gilyarov, M.; El-Battrawy, I.; Akin, I.; Polednikova, K.; Tousek, P.; Winchester, D. E.; Galuszka, J.; Ukena, C.; Poglajen, G.; Carrilho-Ferreira, P.; Hauck, C.; Paolini, C.; Bilato, C.; Kobayashi, Y.; Shoji, T.; Ishibashi, I.; Takahara, M.; Himi, T.; Din, J.; Al-Shammari, A.; Prasad, A.; Rihal, C. S.; Liu, K.; Schulze, P. C.; Bianco, M.; Jorg, L.; Rickli, H.; Pestana, G.; Nguyen, T. H.; Bohm, M.; Maier, L. S.; Pinto, F. J.; Widimsky, P.; Felix, S. B.; Braun-Dullaeus, R. C.; Rottbauer, W.; Hasenfuss, G.; Pieske, B. M.; Schunkert, H.; Borggrefe, M.; Thiele, H.; Bauersachs, J.; Katus, H. A.; Horowitz, J. D.; Di Mario, C.; Munzel, T.; Crea, F.; Bax, J. J.; Luscher, T. F.; Ruschitzka, F.; Ghadri, J. R.; Opolski, G.; Templin, C.

doi:10.1016/j.jacc.2020.02.057

Background: Takotsubo syndrome (TTS) occurs predominantly in post-menopausal women but is also found in younger patients. Objectives: This study aimed to investigate age-related differences in TTS. Methods: Patients diagnosed with TTS and enrolled in the International Takotsubo Registry between January 2011 and February 2017 were included in this analysis and were stratified by age (younger: ≤50 years, middle-age: 51 to 74 years, elderly: ≥75 years). Baseline characteristics, hospital course, as well as short- and long-term mortality were compared among groups. Results: Of 2,098 TTS patients, 242 (11.5%) patients were ≤50 years of age, 1,194 (56.9%) were 51 to 74 years of age, and 662 (31.6%) were ≥75 years of age. Younger patients were more often men (12.4% vs. 10.9% vs. 6.3%; p = 0.002) and had an increased prevalence of acute neurological (16.3% vs. 8.4% vs. 8.8%; p = 0.001) or psychiatric disorders (14.1% vs. 10.3% vs. 5.6%; p < 0.001) compared with middle-aged and elderly TTS patients. Furthermore, younger patients had more often cardiogenic shock (15.3% vs. 9.1% vs. 8.1%; p = 0.004) and had a numerically higher in-hospital mortality (6.6% vs. 3.6% vs. 5.1%; p = 0.07). At multivariable analysis, younger (odds ratio: 1.60; 95% confidence interval: 0.86 to 3.01; p = 0.14) and older age (odds ratio: 1.09; 95% confidence interval: 0.66 to 1.80; p = 0.75) were not independently associated with in-hospital mortality using the middle-aged group as a reference. There were no differences in 60-day mortality rates among groups. Conclusions: A substantial proportion of TTS patients are younger than 50 years of age. TTS is associated with severe complications requiring intensive care, particularly in younger patients.

Age-Related Variations in Takotsubo Syndrome / Cammann V.L.; Szawan K.A.; Stahli B.E.; Kato K.; Budnik M.; Wischnewsky M.; Dreiding S.; Levinson R.A.; Di Vece D.; Gili S.; Citro R.; Bossone E.; Neuhaus M.; Franke J.; Meder B.; Jaguszewski M.; Noutsias M.; Knorr M.; Heiner S.; D'Ascenzo F.; Dichtl W.; Burgdorf C.; Kherad B.; Tschope C.; Sarcon A.; Shinbane J.; Rajan L.; Michels G.; Pfister R.; Cuneo A.; Jacobshagen C.; Karakas M.; Koenig W.; Pott A.; Meyer P.; Roffi M.; Banning A.; Wolfrum M.; Cuculi F.; Kobza R.; Fischer T.A.; Vasankari T.; Airaksinen K.E.J.; Napp L.C.; Dworakowski R.; MacCarthy P.; Kaiser C.; Osswald S.; Galiuto L.; Chan C.; Bridgman P.; Beug D.; Delmas C.; Lairez O.; Gilyarova E.; Shilova A.; Gilyarov M.; El-Battrawy I.; Akin I.; Polednikova K.; Tousek P.; Winchester D.E.; Galuszka J.; Ukena C.; Poglajen G.; Carrilho-Ferreira P.; Hauck C.; Paolini C.; Bilato C.; Kobayashi Y.; Shoji T.; Ishibashi I.; Takahara M.; Himi T.; Din J.; Al-Shammari A.; Prasad A.; Rihal C.S.; Liu K.; Schulze P.C.; Bianco M.; Jorg L.; Rickli H.; Pestana G.; Nguyen T.H.; Bohm M.; Maier L.S.; Pinto F.J.; Widimsky P.; Felix S.B.; Braun-Dullaeus R.C.; Rottbauer W.; Hasenfuss G.; Pieske B.M.; Schunkert H.; Borggrefe M.; Thiele H.; Bauersachs J.; Katus H.A.; Horowitz J.D.; Di Mario C.; Munzel T.; Crea F.; Bax J.J.; Luscher T.F.; Ruschitzka F.; Ghadri J.R.; Opolski G.; Templin C.. - In: JOURNAL OF THE AMERICAN COLLEGE OF CARDIOLOGY. - ISSN 0735-1097. - ELETTRONICO. - 75:(2020), pp. 1869-1877. [10.1016/j.jacc.2020.02.057]