Elsevier

The American Journal of Medicine

Volume 128, Issue 6, June 2015, Pages 654.e11-654.e19
The American Journal of Medicine

AJM online
Clinical research study
Comorbidities Frequency in Takotsubo Syndrome: An International Collaborative Systematic Review Including 1109 Patients

https://doi.org/10.1016/j.amjmed.2015.01.016Get rights and content

Abstract

Background

To identify predisposing factors that can result in the onset of takotsubo syndrome, we performed an international, collaborative systematic review focusing on clinical characteristics and comorbidities of patients with takotsubo syndrome.

Methods

We searched and reviewed cited references up to August 2013 to identify relevant studies. Corresponding authors of selected studies were contacted and asked to provide additional quantitative details. Data from each study were extracted by 2 independent reviewers. The cumulative prevalence of presenting features and comorbidities was assessed. Nineteen studies whose authors sent the requested information were included in the systematic review, with a total of 1109 patients (951 women; mean age, 59-76 years). Evaluation of risk factors showed that obesity was present in 17% of patients (range, 2%-48%), hypertension in 54% (range, 27%-83%), dyslipidemia in 32% (range, 7%-59%), diabetes in 17% (range, 4%-34%), and smoking in 22% (range, 6%-49%). Emotional stressors preceded takotsubo syndrome in 39% of patients and physical stressors in 35%. The most common comorbidities were psychological disorders (24%; range, 0-49%), pulmonary diseases (15%; range, 0-22%), and malignancies (10%; range, 4%-29%). Other common associated disorders were neurologic diseases (7%; range, 0-22%), chronic kidney disease (7%; range, 2%-27%), and thyroid diseases (6%; range, 0-37%).

Conclusions

Patients with takotsubo syndrome have a relevant prevalence of cardiovascular risk factors and associated comorbidities. Such of associations needs to be evaluated in further studies.

Section snippets

Study Design

This systematic review was conducted following current guidelines, including the Cochrane Collaboration and Meta-analysis Of Observational Studies in Epidemiology,11 and the Preferred Reporting Items for Systematic reviews and Meta-Analyses amendment to the Quality of Reporting of Meta-analyses statement.12 The study was registered at the PROSPERO International prospective register of systematic reviews of the University of York, United Kingdom (registration no. CRD42013005175).13 All

Search Results

From a total of 295 initial citations that were found, we excluded those with duplicate reporting, as well as those that were reviews, were not written in English, or included small case series of patients or patients who were not diagnosed as having takotsubo syndrome on the basis of the Mayo Clinic criteria. Corresponding authors of the 87 studies that were selected according to explicit inclusion criteria were asked to participate in the COUNTS study. We then sent the study protocol and a

Discussion

The COUNTS Study has successfully merged 19 databases of previously published series of patients with takotsubo syndrome. Together, these databases comprise a total of >1100 patients with takotsubo syndrome, and therefore this is the largest collaborative review of such patients with detailed clinical data that has been conducted to date. The major finding of the study is that patients with takotsubo syndrome have a relevant prevalence of cardiovascular risk factors, with frequency similar to

Conclusions

The COUNTS study provides a unique substrate to support a reliable definition of clinical characteristics of patients with takotsubo syndrome. Indeed, the demonstration, in the largest series of patients with takotsubo syndrome reported to date, that cardiovascular risk factors and some comorbidities known to be associated with excessive catecholamine production have a high prevalence in patients with takotsubo syndrome supports the concept that “predisposing factors” may play a crucial

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    Funding: None.

    Conflict of Interest: None.

    Authorship: All authors had access to the data and played a role in writing the manuscript.

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