Takotsubo syndrome in real-world practice: a tertiary centre case series

Introduction

Takotsubo syndrome (TTS) is characterized by reversible left ventricular dysfunction. Despite generally favorable prognosis, the acute phase can be severe. We aimed to describe the clinical features, in-hospital course and long-term outcomes of TTS patients in a tertiary centre.

Methods

This retrospective study included all patients diagnosed with TTS at a tertiary centre from June 2012 to March 2025, using InterTAK Criteria. Data was collected from medical records.

Results

We included 137 patients (85.4% female), with a mean age of 70.7 ± 12.3 years (table). Most of the patients were retired (77.9%) and married (52.5%). Common comorbidities were hypertension (83.2%), dyslipidemia (52.6%), obesity (35.3%), diabetes (24.8%) and smoking (20.5%). Psychiatric disorders included anxiety (24.1%), depression (55.2%) and sleep disturbances (6.9%). 73% of the patients had an identified trigger (34.4% emotional, 38.5% physical). Median hospital stay was 7 days. Complications included acute heart failure (23.4%), cardiogenic shock (8%), ventricular tachycardia (6.6%), ventricular fibrillation (1.5%), and cardiac arrest (2.2%).

On admission, 90.5% of the patients had sinus rhythm, ST-elevation was observed in 46.7%, ST-depression in 23.4%, T-wave inversion in 43.2% and left bundle branch block in 7.3%. The mean QTc was 454.3 ± 48.2 ms. Echocardiography showed apical TTS in 84.7% of the patients, midventricular in 8.8%, focal in 5.8% and inverted in 0.7%. Left ventricular ejection fraction (LVEF) improved from 42.5 ± 10.2% at admission to 50.5 ± 11.8% at discharge. Mitral regurgitation was present in 43.4% (mild to moderate in 42.7% and severe in 0.8%). Apical thrombus, ventricular septal defect and left ventricular rupture occurred in 0.7% of the patients each. The median of peak T troponin T was 431.5 [746.5] ng/mL and the median of peak NT-proBNP was 4980.8 [16742.0] pg/mL. ACEi/ARBs were started in 57.9% of the patients, statins in 53.4%, beta-blockers in 24.1% and aspirin in 33.6%. At discharge, ACEi/ARBs were continued in 83.1%, beta-blockers in 66.2%, statins in 70.1% and aspirin in 47.4%. During follow-up 18.8% died, 33.6% were hospitalized (11.7% due to cardiovascular cause), 1.4% had TTS recurrence, 3.7% had myocardial infarction and 2.3% had stroke.

Conclusions

TTS mainly affected elderly women with cardiovascular comorbidities. LVEF usually recovered and recurrence was low. Early recognition and guideline-directed therapy are essential for favorable outcomes.