Takotubo syndrome: more fatal in males

Roma, Italy Takotsubo syndrome is far more common in women than men, but men are much more likely to die from it, a new study shows [1].

In an analysis of nearly 2,500 Takotsubo syndrome (TTS) patients enrolled in an international registry, men, who comprised only 11% of the sample, had a significantly higher rate of cardiogenic shock and were twice as likely to be hospitalized to die than their own female counterparts.

The authors concluded that TTTS in men requires close hospital monitoring and long-term follow-up. Their study was published in the Journal of the American College of Cardiology[1].

Takotsubo syndrome is a condition characterized by acute heart failure and transient ventricular contractile dysfunction that can be triggered by acute emotional or physical stress. It primarily affects women, particularly postmenopausal women, although the reasons for this are not yet fully understood, the wrote dr Luca Arcari from the Institute of Cardiology of the Madre Giuseppina Vannini Hospital, Rome, and colleagues.

The syndrome also affects men, and recent data has shown that being male is associated with poorer outcomes. However, because it is relatively uncommon in men, information about outcomes in them is limited.

To better understand the impact of gender on TTTS, the researchers studied 2,492 TTTS patients (286 males, 2,206 females) who participated in the registry. GHOST (German Italian Spanish Takotsubo) and compared the clinical features and short- and long-term outcomes of the two groups.

Male patients were significantly younger (69 years old) than female patients (71 years old; p=0.005) and had a higher prevalence of comorbidities, including diabetes (25% vs. 19%; p=0.01), lung disease (21% versus 15%; P=0.006) and malignancies (25% versus 13%; P<0.001).

In addition, physical triggers were more likely to cause TTTS in males (55% vs 32%; P<0.01), while emotional triggers were more common in females (39% vs 19%; P<0.001).

The researchers then performed a propensity score analysis by matching males and females in a 1:1 ratio, resulting in 207 patients in each group.

After propensity score matching, male patients had higher rates of cardiogenic shock (16% versus 6%) and in-hospital mortality (8% versus 3%; p<0.05 in both cases).

Men also had a higher mortality rate during acute and long-term follow-up. Male gender remained independent of both in-hospital mortality (odds ratio, 2.26; 95% confidence interval, 1.16-4.40) and long-term mortality (hazard ratio, 1.83; 95% CI, 1.32-4.40). 2.52).

The study by Arcari and colleagues “convincingly shows that although men are much less likely to develop TTTS than women, they have more serious complications and are more likely to die than women with TTTS syndrome,” the wrote dr Ilan S. Wittstein from Johns Hopkins University, Baltimore, in an editorial accompanying the study [2].

In an interview, Dr. Wittstein, one of the strengths of the study is its size.

“In recent years there have been many studies, but smaller and carried out in one center. Here, this large registry had more than 2,000 patients. So when researchers say the TTTS rate is 10% in men and 90% in women, that’s not necessarily surprising because that’s the breakdown we’ve known from the start, but that finding is corroborated here by a large cohort “, he said.

“I think what’s new about the work is that the size of the cohort allowed the researchers to perform propensity matching, which allowed them not only to compare males and females, but also to perform a 1:1 comparison. And they found that men are much more seriously ill, even when men and women are matched for different comorbidities.

“What makes this syndrome intriguing and different from most heart muscle problems is that in the majority of patients, the disease is triggered by an acute stressor,” said Dr. Wittstein.

“It can be an emotional trigger, like the announcement of the death of a loved one. That’s why we called this syndrome “Broken Heart Syndrome” many years ago. Or it could be a physical trigger, which can be a variety of things like an infection, a stroke, bad pneumonia, anything that takes a toll on the body and triggers a stress response. Ordinary heart attacks are not triggered that way,” he said.

Drs. Arcari and Wittstein disclosed no relevant financial relationships.

The article was originally published on Medscape.fr under the title “Takotsubo Syndrome More Deadly in Men”. Translated by Stephanie Lavaud.

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