PRIMARY VERSUS SECONDARY TYPE OF TAKOTSUBO SYNDROME

Aim
Takotsubo syndrome (TTS) often develop subsequently after initial hospitalization for serious non-cardiac disease. The incidence of such „secondary“ TTS is rising due to closer interdisciplinary cooperation. The aim of the study is to compare patients it those TTS was the primary reason for admission with patients with secondary TTS.
Sample and Methodology
Patients hospitalized with TTS in a large university hospital were identified and prospectively included in this monocentric study between 2013 and 2023. A total of 155 patients were diagnosed with TTS. All of them had to meet the international InterTAK diagnostic criteria. We divided the patients into two groups: Group A (primary TTS) included patients who were admitted with primarily acute cardiac involvement and the suspicion of TTS which we definitively concluded as TTS. Group B (secondary TTS) included patients admitted for non-cardiac severe disability, who were diagnosed with TTS based on new onset of symptoms after initial hospitalization.
Results
Group A (primary TTS) included 97 patients and there were 58 patients in the Group B (secondary TTS). We didn’t recognise any diffrences in the baseline characteristics: 91% female in both groups with the same average age of 71 years. Ejection fraction in Group A and B was 36,1±7,6% vs. 34,5±6,6% (p=0.306), respectively. The time from admission to development of diagnosed secondary TTS was 5.3±5.4 days. Development of cardiogenic shock was seen in group A in 6.3% vs. 27.6% in group B (p<0.001). The hospital mortality in group A was 6.2% vs. 15.5% in group B (p=0.057).
Conclusion
More than one third of patients from our registry had secondary type of TTS induced by another primary non-cardiac disease. Eventhough primary and secondary type of TSS did not differ in age and ejection fraction, secondary type of TSS was associated with worse prognosis.