- 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.
- 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.
- 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.