Abstract
Cardiac alterations are frequently observed after acute neurological disorders. Takotsubo syndrome (TTS) represents an acute heart failure syndrome and is increasingly recognized as part of the spectrum of cardiac complications observed after neurological disorders. A systematic investigation of TTS patients with neurological disorders has not been conducted yet. The aim of the study was to expand insights regarding neurological disease entities triggering TTS and to investigate the clinical profile and outcomes of TTS patients after primary neurological disorders. The International Takotsubo Registry is an observational multicenter collaborative effort of 45 centers in 14 countries (ClinicalTrials.gov, identifier NCT01947621). All patients in the registry fulfilled International Takotsubo Diagnostic Criteria. For the present study, patients were included if complete information on acute neurological disorders were available. 2402 patients in whom complete information on acute neurological status were available were analyzed. In 161 patients (6.7%) an acute neurological disorder was identified as the preceding triggering factor. The most common neurological disorders were seizures, intracranial hemorrhage, and ischemic stroke. Time from neurological symptoms to TTS diagnosis was ≤ 2 days in 87.3% of cases. TTS patients with neurological disorders were younger, had a lower female predominance, fewer cardiac symptoms, lower left ventricular ejection fraction, and higher levels of cardiac biomarkers. TTS patients with neurological disorders had a 3.2-fold increased odds of in-hospital mortality compared to TTS patients without neurological disorders. In this large-scale study, 1 out of 15 TTS patients had an acute neurological condition as the underlying triggering factor. Our data emphasize that a wide spectrum of neurological diseases ranging from benign to life-threatening encompass TTS. The high rates of adverse events highlight the need for clinical awareness.
Highlights
Cardiac alterations are frequently observed after acute neurological disorders
A cross-sectional study based on national inpatient sample data has shown that 0.06% of hospitalization for primary acute neurological disorders are complicated by Takotsubo syndrome (TTS) and that incidence rates of TTS diagnosis among patients with acute neurological disorders have gradually increased during the entire study period[12]
The present study based on data from the InterTAK Registry demonstrates that neurological disorders are common triggering factors of TTS
Summary
Takotsubo syndrome (TTS) represents an acute heart failure syndrome and is increasingly recognized as part of the spectrum of cardiac complications observed after neurological disorders. In 161 patients (6.7%) an acute neurological disorder was identified as the preceding triggering factor. TTS patients with neurological disorders had a 3.2-fold increased odds of in-hospital mortality compared to TTS patients without neurological disorders In this large-scale study, 1 out of 15 TTS patients had an acute neurological condition as the underlying triggering factor. We have designed the present study to extensively investigate frequency and spectrum of neurological disorders, clinical characteristics, and outcomes of patients with TTS and primary neurological disorders from the International Takotsubo Registry
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