Systematic review and meta-analysis of incidence and correlates of recurrence of takotsubo cardiomyopathy☆
Introduction
Takotsubo cardiomyopathy (TTC) is now a well-known cardiac condition that predominantly affects women and can be associated with acute and chronic complications. Interestingly, TTC was first reported only 25 years ago in Japan and one of the earliest descriptions in humans was even more recent [1]. The acute stage of the disease can be complicated by hypotension, shock, arrhythmias, heart failure and death [2]. While our understanding of acute complication is clear, the knowledge of the natural history and long term TTC complications is limited because of relatively small number and limited follow-up of the patients. Recurrence of TTC is common and is a well reported long term issue in TTC cohort [3]. However, the exact incidence and correlates of recurrence are not known. We therefore performed a meta-analysis and systematic review to determine the global incidence of recurrence of TTC and to consolidate the evidence.
In the current study, we sought to determine utilizing a systematic review/meta-analysis approach the incidence of recurrence of TTC episodes and cause of its variability. We also prospectively evaluated the impact of discharge medications, left ventricular ejection fraction (LVEF) and type of stressor during initial episode on recurrence.
Section snippets
Methods
This systematic review and meta-analysis is reported according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement guidelines. We included comparative studies of any design (randomized control trials, cohort, case control and cross sectional). Eligible studies needed to have ≥ 5 patients and a minimum follow-up of 3 months with confirmed documentation of recurrence of TTC. Inclusion of studies was limited to English language and foreign studies where
Results
The literature search on TTC and recurrence yielded 298 citations. The abstracts of all the 298 citations were reviewed and 58 articles were chosen for full text review. Of the 58 articles chosen for the full text review, 34 were selected as per the inclusion and exclusion criteria. Six out of 34 studies were noted to be duplicated (from the same group with overlapping patient data sets) and were excluded. Additional 3 articles were found on the hand search leading to a total of 31 [23], [24],
Discussion
There is general agreement that TTC is usually precipitated by exposure to a “pulse” of released or administered catecholamines [6], [7] and that individual susceptibility varies, being greater in aging females [8]. Furthermore, recurrence of TTC has been noted to be a problem from the earliest series [9] and definite management strategies regarding preventive treatment are awaiting appropriately designed trials. The complex nature of this disorder and lack of clear knowledge of pathogenesis
Acknowledgment
This work was supported in part by research grants from the National Health and Medical Research Council of Australia Grant Number APP 565404. Kuljit Singh and Ranjit Shah are supported in part by PhD scholarship from the University of Adelaide. J. Horowitz is co-inventor of a patent entitled: “Method for preventing and/or treating a stress induced cardiomyopathy” filed by the University of Adelaide.
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Disclosures: None.