Cardiology Department, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
Cardiology Department, Hospital Clínico San Carlos, Madrid, Spain; Faculty of Biomedical and Health Sciences, Universidad Europea de Madrid, Spain.
Am J Cardiol. 2023 Oct 15;205:58-62. doi: 10.1016/j.amjcard.2023.07.155. Epub 2023 Aug 15.
The risk of recurrence in takotsubo syndrome (TTS) appears to be low, although previous studies have shown conflicting results and factors associated with recurrences are unclear. The aim of this study is to evaluate the incidence and predictors of TTS recurrences. Adult patients included in the Spanish Multicenter REgistry of TAKOtsubo syndrome (RETAKO) between January 2003 and September 2019 were identified. Patients were categorized based on recurrences during follow-up and a multivariate logistic regression model was used to identify factors associated with recurrences. A total of 1097 patients (mean age 71.0±11.9 years, 87% females) were included, repeated TTS events were documented in 44 patients (4.0%), including 13 patients with prior TTS and 31 patients with recurrent TTS during a median follow-up of 279 days. Two patients (0.02%) had two episodes of recurrence. Compared to patients who had no recurrence of TTS, those with recurrent TTS more frequently had no identifiable stressful trigger in the index admission (20 [64.5%] vs 352 [33.0%], p <0.001). Primary TTS, defined as TTS without physical trigger, was also more common in the recurrence group (93.5% vs 68.3%, p <0.001). The only factor independently associated with recurrences was the absence of an identifiable trigger (odds ratio 3.7 [95% confidence interval 1.8-7.8], p=0.001). In conclusion, our data indicate that for patients presenting with TTS, the rate of early recurrent TTS is approximately 4% per year. Among TTS patients, those who have no identifiable trigger events appear to have a higher rate of recurrence.
在 Takotsubo 综合征（TTS）中，复发的风险似乎较低，尽管先前的研究结果存在差异，并且与复发相关的因素尚不清楚。本研究旨在评估 TTS 复发的发生率和预测因素。确定了 2003 年 1 月至 2019 年 9 月期间纳入西班牙多中心 Takotsubo 综合征登记研究（RETAKO）的成年患者。根据随访期间的复发情况对患者进行分类，并使用多变量逻辑回归模型来确定与复发相关的因素。共纳入 1097 例患者（平均年龄 71.0±11.9 岁，87%为女性），44 例（4.0%）患者记录到重复 TTS 事件，其中 13 例患者既往有 TTS，31 例患者在中位随访 279 天内发生复发性 TTS。有 2 例（0.02%）患者发生两次复发。与没有 TTS 复发的患者相比，复发 TTS 的患者在指数入院时更频繁地没有可识别的应激触发因素（20[64.5%]例比 352[33.0%]例，p<0.001）。原发性 TTS（定义为无物理触发的 TTS）在复发组中也更为常见（93.5%比 68.3%，p<0.001）。与复发相关的唯一独立因素是无法识别的触发因素（优势比 3.7[95%置信区间 1.8-7.8]，p=0.001）。总之，我们的数据表明，对于出现 TTS 的患者，每年早期复发 TTS 的发生率约为 4%。在 TTS 患者中，那些没有可识别的触发事件的患者似乎具有更高的复发率。
