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• W2346932408 abstract "I read with great interest the article written by Stiermaier et al. on long-term mortality in Takotsubo syndrome (TS) published in this issue of the European Journal of Heart Failure.1 The authors have reported on the long-term mortality in a total of 286 patients with TS, which were matched for age and gender with 286 ST elevation myocardial infarction (STEMI) patients. Long-term mortality during a mean follow-up period of 3.8 ± 2.5 years was significantly higher in TS patients compared with the matched STEMI cohort (24.7% vs. 15.1%). The authors have concluded that long-term mortality in TS exceeded that of patients presenting with STEMI; consequently, TS should no longer be considered a benign disease. I agree with the authors that the disease is not benign during the acute and subacute stages, but I disagree with the period after that. The 28-day mortality in that report was 5.5% in TS and was not different from that of STEMI patients (5.7%). This is absolutely conceivable because of the severe acute LV dysfunction, which may be complicated by heart failure, pulmonary oedema, and cardiogenic shock in the acute stage of TS. Lethal arrhythmias due to a prolonged QT-interval with consequent ventricular arrhythmias and even other complications have been reported in the acute and subacute phases of the disease. However, it is well-known that acute TS is a transient disease, and patients recover completely within days or weeks, with complete normalization of LV function. The question here is why the disease (TS) should be burdened by the complications and mortalities attributable to other co-morbidities, which either have triggered or have been pre-disposing factors for TS. The authors have not reported on the recurrence of TS during the follow-up period in the study or any death related to the recurrence of the disease. The non-cardiovascular mortality in TS patients in the study was 9.6%, which was significantly (p<0.01) higher than that of STEMI patients (3.2%), and this was the main reason for excess long-term mortality in TS patients. In addition, the cause of death in TS patients was unknown in a further 6.6%, which also was higher than the 3.9% in STEMI patients. The non-cardiovascular and the unknown causes of death were more than twice as high in TS patients (16.2) compared with STEMI patients (7.1%). Consequently, long-term mortality in TS patients probably has nothing to do with the disease in 16.2% out of the 24.7% reported mortality in the study. Among the predictors of mortality using univariable Cox regression analysis were apical ballooning, Killip class 3/4 on admission, and initial LVEF <40%, which most probably were decisive factors in the acute and subacute stages of the disease. Further predictors were age >70 years, male sex, physical stressors, and diabetes mellitus, which most probably were attributed to co-morbidities leading to excess non-cardiovascular mortality. Consequently, TS should not be considered as a benign disease in the acute and subacute stages of the disease and should be regarded as a marker for increased long-term non-cardiac mortality. Sharkey et al.2 have reported that all deaths which occurred in TS patients after hospital discharge were from non-cardiac causes, most commonly cancer. Conflict of interest: none declared. Shams Y-Hassan Department of Cardiology Karolinska Institute at Karolinska University Hospital Huddinge S-141 86 Stockholm Sweden Tel: +46 8 58582805 Fax: +46 8 58586710 E-mail: shams.younis-hassan@karolinska.se" @default.
• W2346932408 created "2016-06-24" @default.
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• W2346932408 date "2016-05-02" @default.
• W2346932408 modified "2023-10-16" @default.
• W2346932408 title "Long-term excess mortality in Takotsubo syndrome: is it justified to charge Takotsubo for the excess long-term mortality?" @default.
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• W2346932408 doi "https://doi.org/10.1002/ejhf.554" @default.
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