Takotsubo syndrome is not so benign after all

  • Pelliccia F & al.
  • JACC Heart Fail
  • 2 Jan 2019

  • curated by Jenny Blair, MD
  • Clinical Essentials
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  • Long-term annual mortality after Takotsubo syndrome (TS) is 3.5%; just under 2% of patients die in the hospital.
  • Factors portending poor prognosis are a preceding physical stressor, older age, and acute atypical ballooning (global left ventricular stunning).
  • Prospective studies are needed.
  • Editorial discusses primary vs secondary TS, possible links to extracardiac conditions.

Why this matters

  • Also known as “broken heart syndrome,” TS has long been considered relatively benign, but recent studies challenge that notion.
  • Which acute-phase factors predict long-term prognosis have been unclear.

Key results

  • Mortality rate during index admission: 1.8% (95% CI, 1.2%-2.5%).
  • Median follow-up: 28 months.
  • Long-term annual mortality rate: 3.5% (95% CI, 2.6%-4.5%). 
  • Annual recurrence rate: 1.0% (95% CI, 0.7%-1.3%).
  • On meta-regression, factors associated with:
    • In-hospital mortality: physical stressor preceding illness;
    • Long-term mortality: older age, physical stressor, atypical ballooning; and
    • Recurrence: none.
  • Heart failure at presentation did not predict long-term mortality or recurrence.
  • Similar results on sensitivity analyses.
  • Most studies were high-quality, and publication bias was not detected.

Study design

  • Systematic review and meta-regression analysis of 54 observational studies with ≥6-month follow-up (n=4679).
  • Outcomes: in-hospital mortality, long-term mortality, recurrence rate.
  • Funding: None disclosed.


  • Significant heterogeneity.
  • No comparisons to healthy or to post-acute coronary syndrome populations.

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