Temporal Trends in Takotsubo Syndrome

Victor Schweiger (Zürich)1, V. L. Cammann (Zürich)1, T. Gilhofer (Zürich)2, R. Schlenker (Zürich)2, D. Niederseer (Zürich)1, M. Würdinger (Zürich)1, J.-R. Templin-Ghadri (Zürich)2, D. Di Vece (Zürich)2, C. Templin (Zürich)2

1UniversitätsSpital Zürich Klinik für Kardiologie Zürich, Schweiz; 2UniversitätsSpital Zürich Universitäres Herzzentrum Zürich, Schweiz



Takotsubo syndrome (TTS), historically perceived as a rare and benign cardiac condition, has seen a notable paradigm shift in the past decade. This change was driven by a growing body of evidence suggesting substantial mortality rates associated with TTS, prompting a reevaluation of its clinical significance. Diagnostic criteria have evolved to recognize TTS as a multifactorial disease, acknowledging its complexity.



In this study, data from 3,668 TTS patients diagnosed between 2004 and 2021 were analyzed. Groups were formed based on three consecutive years, and comparative trend analyses were conducted, regarding demographics, risk factors, clinical presentations, and outcomes. Trends in categorical data were compared using the Cochran-Mantel-Haenszel test. Trends in numerical variables were assessed using the Mann-Kendall test. Kaplan-Meier curves were compiled to illustrate mortality rates and outcomes were compared using the log-rank test. 



Over the course of the study, there was a gradual increase in the proportion of male patients (9% to 15%, p<0.001). Apical TTS remained the predominant form, but the diagnosis of midventricular TTS showed an upward trend (18% to 37%, p<0.001). Emotional triggers exhibited stability, while there was a notable increase in the reporting of physical triggers (35% to 50%, p<0.001). Medication prescriptions generally remained constant, with the exception of a decline in aspirin usage (73 to 32%, p<0.001). The incidence of cardiogenic shock rose (7% to 20%, p=0.030), resulting in a higher in-hospital mortality rate (2 to 9%, p<0.001). Notably, the one-year mortality rates significantly increased over the years (p<0.001, Figure 1).



This study underscores the multifactorial nature of TTS and its diverse outcomes, ranging from benign courses to fulminant cardiogenic shock and in-hospital death. The findings emphasize the evolving landscape of TTS, necessitating a more nuanced approach to diagnosis and management as demographics and clinical characteristics change.

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