Takotsubo Cardiomyopathy: Association with Malignancies and Endocrinopathies

Abstract

Background: Takotsubo cardiomyopathy is often preceded by a physical or emotional trigger resulting in transient left ventricular systolic dysfunction. Previous studies have evaluated traditional cardiovascular risk factors, however, possible neurohormonal mechanisms remain uncertain. We sought to explore the neurohormonal milieu associated with takotsubo cardiomyopathy by characterising the prevalence of pre-existing endocrinopathies and non-cutaneous malignancies in patients with takotsubo cardiomyopathy. Methods: This retrospective study analysed demographical and clinical data of 240 cases of takotsubo cardiomyopathy diagnosed across two tertiary centres in Victoria, Australia between 2008 to 2018. Results: Patients were predominantly female (91%) with a mean age of 66 ± 12 years. Forty-two patients (17.5%) had pre-existing endocrinopathy, including thyroid disease (11%), parathyroid disease (1%) and osteoporosis (7%). Thirty-three patients (13%) had a history of non-cutaneous malignancy (see Figure); of these the most common types of malignancy were breast cancer (5%), gastrointestinal (4%), and gynaecological (2%) malignancy. Discussion: Further studies are needed to clarify whether there may be an association between takotsubo cardiomyopathy and metabolic conditions such as endocrinopathies or malignancies. Understanding the neurohormonal milieu may facilitate targeted management of takotsubo cardiomyopathy.