https://doi.org/10.4081/monaldi.2023.2558
Age-sex effect on in-hospital complications and mortality in patients with Takotsubo syndrome. Insights from the National Inpatient Sample
Submitted: February 16, 2023
Accepted: March 29, 2023
Published: April 14, 2023
Accepted: March 29, 2023
Abstract Views: 932
PDF: 219
Publisher's note
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
All claims expressed in this article are solely those of the authors and do not necessarily represent those of their affiliated organizations, or those of the publisher, the editors and the reviewers. Any product that may be evaluated in this article or claim that may be made by its manufacturer is not guaranteed or endorsed by the publisher.
Authors
Age and sex differences in Takotsubo syndrome (TTS) are still a matter of debate. The present study aimed to evaluate the difference in cardiovascular (CV) risk factors, CV disease, in-hospital complications, and death within different sex-age groups. Using the National Inpatient Sample database between 2012 and 2016, 32,474 patients older than 18 years of age hospitalized with the primary diagnosis of TTS were identified. A total of 32,474 patients were enrolled; 27,611 (85.04%) were female. CV risk factors were higher in females, while CV diseases and in-hospital complications were significantly higher in males. The mortality in males was twice as high as that of female patients (9.83% versus 4.58%, p<0.01), and in the logistic regression model after adjustment for confounders, the odds ratio (OR) was 1.79, the confidence interval was 1.60-2.02, and p<0.01. After dividing the group based on age, in-hospital complications were inversely related to age in both sexes, and the length of in-hospital stay was double in the youngest group compared to the oldest one. Mortality increased progressively with age in both groups but was constantly higher in males for each age group. Multiple logistic regression analysis for mortality was performed for the two sexes separately and for the three age groups, considering the youngest one as the reference group. In females, the OR was 1.59 and 2.88, respectively, for groups 2 and 3; for males, the OR was 1.92 and 3.15, all of them statistically significant (p<0.01). In-hospital complications were more common in younger patients with TTS, particularly in males. Mortality was positively correlated with age for both sexes, but mortality was higher in males compared to females in all age groups.
Prasad A, Dangas G, Srinivasan M, et al. Incidence and angiographic characteristics of patients with apical ballooning syndrome (takotsubo/stress cardiomyopathy) in the HORIZONS-AMI trial: an analysis from a multicenter, international study of ST-elevation myocardial infarction. Catheter Cardiovasc Interv 2014;83:343-8.
Bybee KA, Prasad A, Barsness GW, et al. Clinical characteristics and thrombolysis in myocardial infarction frame counts in women with transient left ventricular apical ballooning syndrome. Am J Cardiol 2004;94:343-6.
Redfors B, Vedad R, Angerås O, et al. Mortality in takotsubo syndrome is similar to mortality in myocardial infarction - A report from the SWEDEHEART registry. Int J Cardiol 2015;185:282-9.
Deshmukh A, Kumar G, Pant S, et al. Prevalence of Takotsubo cardiomyopathy in the United States. Am Heart J 2012;164:66-71.e1.
Chen W, Dilsizian V. Exploring the pathophysiology of Takotsubo cardiomyopathy. Curr Cardiol Rep 2017;19:53.
Citro R, Bossone E, Parodi G, et al. Clinical profile and in-hospital outcome of Caucasian patients with takotsubo syndrome and right ventricular involvement. Int J Cardiol 2016;219:455-61.
Ghadri JR, Cammann VL, Templin C. The International Takotsubo Registry: rationale, design, objectives, and first results. Heart Fail Clin 2016;12:597-603.
Ghadri JR, Cammann VL, Napp LC, et al. Differences in the clinical profile and outcomes of typical and atypical Takotsubo syndrome: data from the International Takotsubo Registry. JAMA Cardiol 2016;1:335-40.
Napp LC, Cammann VL, Jaguszewski M, et al. Coexistence and outcome of coronary artery disease in Takotsubo syndrome. Eur Heart J 2020;41:3255-68.
Ghadri JR, Kato K, Cammann VL, et al. Long-term prognosis of patients with takotsubo syndrome. J Am Coll Cardiol 2018;72:874-82.
Wischnewsky MB, Candreva A, Bacchi B, et al. Prediction of short- and long-term mortality in takotsubo syndrome: the InterTAK Prognostic Score. Eur J Heart Fail 2019;21:1469-72.
Aizawa K, Suzuki T. Takotsubo cardiomyopathy: Japanese perspective. Heart Fail Clin 2013;9:243-7.
Stähli BE, Ruschitzka F, Enseleit F. Isolated right ventricular ballooning syndrome: a new variant of transient cardiomyopathy. Eur Heart J 2011;32:1821.
Cammann VL, Szawan KA, Stähli BE, et al. Age-related variations in takotsubo syndrome. J Am Coll Cardiol 2020;75:1869-77.
Bertin N, Brosolo G, Antonini-Canterin F, et al. Takotsubo syndrome in young fertile women. Acta Cardiol 2020;75:235-43.
Tornvall P, Collste O, Ehrenborg E, Järnbert-Petterson H. A case-control study of risk markers and mortality in takotsubo stress cardiomyopathy. J Am Coll Cardiol 2016;67:1931-6.
Stiermaier T, Eitel C, Desch S, et al. Incidence, determinants and prognostic relevance of cardiogenic shock in patients with Takotsubo cardiomyopathy. Eur Heart J Acute Cardiovasc Care 2016;5:489-96.
Agency for Healthcare Research and Quality. HCUP-US Methods Series. Available from: https://www.hcup-us.ahrq.gov/reports/methods/methods.jsp. Accessed on: 6/07/2022.
Elixhauser A, Steiner C, Harris DR, Coffey RM. Comorbidity measures for use with administrative data. Med Care 1998;36:8-27.
Templin C, Ghadri JR, Diekmann J, et al. Clinical features and outcomes of takotsubo (stress) cardiomyopathy. N Engl J Med 2015;373:929-38.
Citro R, Rigo F, D’Andrea A, et al. Echocardiographic correlates of acute heart failure, cardiogenic shock, and in-hospital mortality in tako-tsubo cardiomyopathy. JACC Cardiovasc Imaging 2014;7:119-29.
Medeiros K, O’Connor MJ, Baicu CF, et al. Systolic and diastolic mechanics in stress cardiomyopathy. Circulation 2014;129:1659-67.
Templin C, Napp LC, Ghadri JR. Takotsubo syndrome: underdiagnosed, underestimated, but understood?. J Am Coll Cardiol 2016;67:1937-40.
Vincent LT, Grant J, Ebner B, et al. Effect of gender on prognosis in patients with Takotsubo syndrome (from a nationwide perspective). Am J Cardiol 2022;162:6-12.
Arcari L, Núñez Gil IJ, Stiermaier T, et al. Gender differences in Takotsubo syndrome. J Am Coll Cardiol 2022;79:2085-93.
Lemor A, Ramos-Rodriguez AJ, De La Villa R, et al. Impact of gender on in-hospital outcomes in patients with Takotsubo syndrome: a nationwide analysis from 2006 to 2014. Clin Cardiol 2019;42:13-8.
Murakami T, Yoshikawa T, Maekawa Y, et al. Gender differences in patients with Takotsubo cardiomyopathy: multi-center registry from Tokyo CCU Network. PLoS One 2015;10:e0136655.
Brinjikji W, El-Sayed AM, Salka S. In-hospital mortality among patients with takotsubo cardiomyopathy: a study of the National Inpatient Sample 2008 to 2009. Am Heart J 2012;164:215-21.
Rosner MH. Acute kidney injury in the elderly. In: American Society of Nephrology (ed.), Online curricula: geriatric nephrology. Available from: https://www.asn-online.org/education/distancelearning/curricula/geriatrics/Chapter18.pdf. Accessed on: 12/08/2022.
Wang HE, Muntner P, Chertow GM, Warnock DG. Acute kidney injury and mortality in hospitalized patients. Am J Nephrol 2012;35:349-55.
Misumida N, Ogunbayo GO, Kim SM, et al. Clinical outcome of takotsubo cardiomyopathy diagnosed with or without coronary angiography. Angiology 2019;70:56-61.
Khera R, Light-McGroary K, Zahr F, et al. Trends in hospitalization for takotsubo cardiomyopathy in the United States. Am Heart J 2016;172:53-63.
Pérez-Castellanos A, Martínez-Sellés M, Mejía-Rentería H, et al. Tako-tsubo syndrome in men: rare, but with poor prognosis. Rev Esp Cardiol (Engl Ed) 2018;71:703-8.
Wattanapermpool J, Riabroy T, Preawnim S. Estrogen supplement prevents the calcium hypersensitivity of cardiac myofilaments in ovariectomized rats. Life Sci 2000;66:533-43.
Ueyama T, Kasamatsu K, Hano T, et al. Catecholamines and estrogen are involved in the pathogenesis of emotional stress-induced acute heart attack. Ann N Y Acad Sci 2008;1148:479-85.
Machuki JO, Zhang HY, Harding SE, Sun H. Molecular pathways of oestrogen receptors and β-adrenergic receptors in cardiac cells: recognition of their similarities, interactions and therapeutic value. Acta Physiol (Oxf) 2018;222:e12978.
Fairweather D. Sex differences in inflammation during atherosclerosis. Clin Med Insights Cardiol 2015;8:49-59.
Omerovic E, Citro R, Bossone E, et al. Pathophysiology of Takotsubo syndrome - a joint scientific statement from the Heart Failure Association Takotsubo Syndrome Study Group and Myocardial Function Working Group of the European Society of Cardiology - part 2: vascular pathophysiology, gender and sex hormones, genetics, chronic cardiovascular problems and clinical implications. Eur J Heart Fail 2022;24:274-86.
Liang J, Zhang J, Xu Y, et al. Conventional cardiovascular risk factors associated with Takotsubo cardiomyopathy: a comprehensive review. Clin Cardiol 2021;44:1033-40.
Jurisic S, Gili S, Cammann VL, et al. Clinical predictors and prognostic impact of recovery of wall motion abnormalities in takotsubo syndrome: results from the International Takotsubo Registry. J Am Heart Assoc 2019;8:e011194.
EUGenMed Cardiovascular Clinical Study Group, Regitz-Zagrosek V, Oertelt-Prigione S, et al. Gender in cardiovascular diseases: impact on clinical manifestations, management, and outcomes. Eur Heart J 2016;37:24-34.
How to Cite
Vriz, Olga, Talal Alzahrani, Irene Landi, Ali Hassan Mushtaq, Abdullah Shaik, and Ahmed Nahid Elshaer. 2023. “Age-Sex Effect on in-Hospital Complications and Mortality in Patients With Takotsubo Syndrome. Insights from the National Inpatient Sample”. Monaldi Archives for Chest Disease 94 (1). https://doi.org/10.4081/monaldi.2023.2558.
Copyright (c) 2023 The Author(s)
This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
PAGEPress has chosen to apply the Creative Commons Attribution NonCommercial 4.0 International License (CC BY-NC 4.0) to all manuscripts to be published.
