Neurological Disorders in Takotsubo Syndrome: Clinical Phenotypes and Outcomes
Background Neurological disorders as a risk factor for Takotsubo syndrome (TTS) are not well characterized. The aim of the study was to evaluate TTS‐associated neurological phenotypes and outcome. Methods and Results Patients with TTS enrolled in the international multicenter GEIST (German Italian S...
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Wiley
2024-02-01
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| Series: | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
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| Online Access: | https://www.ahajournals.org/doi/10.1161/JAHA.123.032128 |
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| author | Francesco Santoro Iván J. Núñez Gil Luca Arcari Enrica Vitale Tommaso Martino Ibrahim El‐Battrawy Federico Guerra Giuseppina Novo Enrica Mariano Beatrice Musumeci Luca Cacciotti Pasquale Caldarola Roberta Montisci Ilaria Ragnatela Rosa Cetera Oscar Vedia Emilia Blanco Javier Lopez Pais Agustin Martin Alberto Pérez‐Castellanos Jorge Salamanca Francesco Bartolomucci Ibrahim Akin Holger Thiele Ingo Eitel Thomas Stiermaier Natale Daniele Brunetti |
| author_facet | Francesco Santoro Iván J. Núñez Gil Luca Arcari Enrica Vitale Tommaso Martino Ibrahim El‐Battrawy Federico Guerra Giuseppina Novo Enrica Mariano Beatrice Musumeci Luca Cacciotti Pasquale Caldarola Roberta Montisci Ilaria Ragnatela Rosa Cetera Oscar Vedia Emilia Blanco Javier Lopez Pais Agustin Martin Alberto Pérez‐Castellanos Jorge Salamanca Francesco Bartolomucci Ibrahim Akin Holger Thiele Ingo Eitel Thomas Stiermaier Natale Daniele Brunetti |
| author_sort | Francesco Santoro |
| collection | DOAJ |
| description | Background Neurological disorders as a risk factor for Takotsubo syndrome (TTS) are not well characterized. The aim of the study was to evaluate TTS‐associated neurological phenotypes and outcome. Methods and Results Patients with TTS enrolled in the international multicenter GEIST (German Italian Spanish Takotsubo) registry were analyzed. Prevalence, clinical characteristics, and short‐ and long‐term outcomes of patients with TTS were recorded. A subgroup analysis of the 5 most represented neurological disorders was performed. In total, 400 (17%) of 2301 patients had neurological disorders. The most represented neurological conditions were previous cerebrovascular events (39%), followed by neurodegenerative disorders (30.7%), migraine (10%), epilepsy (9.5%), and brain tumors (5%). During hospitalization, patients with neurological disorders had longer in‐hospital stay (8 [interquartile range, 5–12] versus 6 [interquartile range, 5–9] days; P<0.01) and more often experienced in‐hospital complications (27% versus 16%; P=0.01) mainly driven by cardiogenic shock and in‐hospital death (12% versus 7.6% and 6.5% versus 2.8%, respectively; both P<0.01). Survival analysis showed a higher mortality rate in neurological patients both at 60 days and long‐term (8.8% versus 3.4% and 23.5% versus 10.1%, respectively; both P<0.01). Neurological disorder was an independent predictor of both the 60‐day and long‐term mortality rate (odds ratio, 1.78 [95% CI, 1.07–2.97]; P=0.02; hazard ratio, 1.72 [95% CI, 1.33–2.22]; both P<0.001). Patients with neurodegenerative disorders had the worst prognosis among the neurological disease subgroups, whereas patients with TTS with migraine had a favorable prognosis (long‐term mortality rates, 29.2% and 9.7%, respectively). Conclusions Neurological disorders identify a high‐risk TTS subgroup for enhanced short‐ and long‐term mortality rate. Careful recognition of neurological disorders and phenotype is therefore needed. |
| format | Article |
| id | doaj-art-6dfed6866a3d43208f86f02084d41e23 |
| institution | OA Journals |
| issn | 2047-9980 |
| language | English |
| publishDate | 2024-02-01 |
| publisher | Wiley |
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| series | Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease |
| spelling | doaj-art-6dfed6866a3d43208f86f02084d41e232025-08-20T02:26:40ZengWileyJournal of the American Heart Association: Cardiovascular and Cerebrovascular Disease2047-99802024-02-0113410.1161/JAHA.123.032128Neurological Disorders in Takotsubo Syndrome: Clinical Phenotypes and OutcomesFrancesco Santoro0Iván J. Núñez Gil1Luca Arcari2Enrica Vitale3Tommaso Martino4Ibrahim El‐Battrawy5Federico Guerra6Giuseppina Novo7Enrica Mariano8Beatrice Musumeci9Luca Cacciotti10Pasquale Caldarola11Roberta Montisci12Ilaria Ragnatela13Rosa Cetera14Oscar Vedia15Emilia Blanco16Javier Lopez Pais17Agustin Martin18Alberto Pérez‐Castellanos19Jorge Salamanca20Francesco Bartolomucci21Ibrahim Akin22Holger Thiele23Ingo Eitel24Thomas Stiermaier25Natale Daniele Brunetti26Department of Medical and Surgical Sciences University of Foggia Foggia ItalyInterventional; Cardiology, Cardiovascular Institute, Hospital Clínico Universitario San Carlos Madrid SpainInstitute of Cardiology, Madre Giuseppina Vannini Hospital Rome ItalyDepartment of Medical and Surgical Sciences University of Foggia Foggia ItalyDepartment of Neuroscience, Neurology‐Stroke Unit University Hospital Foggia ItalyDepartment of Cardiology University of Mannheim Mannheim GermanyCardiology and Arrhythmology Clinic Marche Polytechnic University, University Hospital “Umberto I – Lancisi – Salesi” Ancona ItalyDepartment of Health Promotion, Mother and Child Care, Internal Medicine and Medical Specialties, Cardiology Unit University of Palermo, University Hospital P Palermo ItalyDivision of Cardiology, University of Rome Tor Vergata Rome ItalyCardiology, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology Sapienza University of Rome Rome ItalyInstitute of Cardiology, Madre Giuseppina Vannini Hospital Rome ItalyDepartment of Cardiology, San Paolo Hospital Bari ItalyClinical Cardiology, Department of Medical Science and Public Health University of Cagliari Cagliari ItalyDepartment of Medical and Surgical Sciences University of Foggia Foggia ItalyDepartment of Medical and Surgical Sciences University of Foggia Foggia ItalyInterventional; Cardiology, Cardiovascular Institute, Hospital Clínico Universitario San Carlos Madrid SpainDepartment of Cardiology University Hospital Arnau de Vilanova Lleida SpainDepartment of Cardiology, Hospital de Orense Orense SpainDepartment of Cardiology University hospital Salamanca SpainDepartment of Cardiology, Hospital Son Espases, Palma de Mallorca Islas Baleares SpainDepartment of Cardiology, Hospital de La Princesa Madrid SpainDepartment of Cardiology, Bonomo Hospital Andria ItalyDepartment of Cardiology University of Mannheim Mannheim GermanyDepartment of Internal Medicine/Cardiology Heart Center Leipzig at University of Leipzig and Leipzig Heart Institute Leipzig GermanyUniversity Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck GermanyUniversity Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine) and German Center for Cardiovascular Research (DZHK), partner site Hamburg/Kiel/Lübeck Lübeck GermanyDepartment of Medical and Surgical Sciences University of Foggia Foggia ItalyBackground Neurological disorders as a risk factor for Takotsubo syndrome (TTS) are not well characterized. The aim of the study was to evaluate TTS‐associated neurological phenotypes and outcome. Methods and Results Patients with TTS enrolled in the international multicenter GEIST (German Italian Spanish Takotsubo) registry were analyzed. Prevalence, clinical characteristics, and short‐ and long‐term outcomes of patients with TTS were recorded. A subgroup analysis of the 5 most represented neurological disorders was performed. In total, 400 (17%) of 2301 patients had neurological disorders. The most represented neurological conditions were previous cerebrovascular events (39%), followed by neurodegenerative disorders (30.7%), migraine (10%), epilepsy (9.5%), and brain tumors (5%). During hospitalization, patients with neurological disorders had longer in‐hospital stay (8 [interquartile range, 5–12] versus 6 [interquartile range, 5–9] days; P<0.01) and more often experienced in‐hospital complications (27% versus 16%; P=0.01) mainly driven by cardiogenic shock and in‐hospital death (12% versus 7.6% and 6.5% versus 2.8%, respectively; both P<0.01). Survival analysis showed a higher mortality rate in neurological patients both at 60 days and long‐term (8.8% versus 3.4% and 23.5% versus 10.1%, respectively; both P<0.01). Neurological disorder was an independent predictor of both the 60‐day and long‐term mortality rate (odds ratio, 1.78 [95% CI, 1.07–2.97]; P=0.02; hazard ratio, 1.72 [95% CI, 1.33–2.22]; both P<0.001). Patients with neurodegenerative disorders had the worst prognosis among the neurological disease subgroups, whereas patients with TTS with migraine had a favorable prognosis (long‐term mortality rates, 29.2% and 9.7%, respectively). Conclusions Neurological disorders identify a high‐risk TTS subgroup for enhanced short‐ and long‐term mortality rate. Careful recognition of neurological disorders and phenotype is therefore needed.https://www.ahajournals.org/doi/10.1161/JAHA.123.032128neurological diseaserisk stratificationTakotsubo syndrome |
| spellingShingle | Francesco Santoro Iván J. Núñez Gil Luca Arcari Enrica Vitale Tommaso Martino Ibrahim El‐Battrawy Federico Guerra Giuseppina Novo Enrica Mariano Beatrice Musumeci Luca Cacciotti Pasquale Caldarola Roberta Montisci Ilaria Ragnatela Rosa Cetera Oscar Vedia Emilia Blanco Javier Lopez Pais Agustin Martin Alberto Pérez‐Castellanos Jorge Salamanca Francesco Bartolomucci Ibrahim Akin Holger Thiele Ingo Eitel Thomas Stiermaier Natale Daniele Brunetti Neurological Disorders in Takotsubo Syndrome: Clinical Phenotypes and Outcomes Journal of the American Heart Association: Cardiovascular and Cerebrovascular Disease neurological disease risk stratification Takotsubo syndrome |
| title | Neurological Disorders in Takotsubo Syndrome: Clinical Phenotypes and Outcomes |
| title_full | Neurological Disorders in Takotsubo Syndrome: Clinical Phenotypes and Outcomes |
| title_fullStr | Neurological Disorders in Takotsubo Syndrome: Clinical Phenotypes and Outcomes |
| title_full_unstemmed | Neurological Disorders in Takotsubo Syndrome: Clinical Phenotypes and Outcomes |
| title_short | Neurological Disorders in Takotsubo Syndrome: Clinical Phenotypes and Outcomes |
| title_sort | neurological disorders in takotsubo syndrome clinical phenotypes and outcomes |
| topic | neurological disease risk stratification Takotsubo syndrome |
| url | https://www.ahajournals.org/doi/10.1161/JAHA.123.032128 |
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