Contribution of Seasonal Variation and Inflammation to Increased In-Hospital Events and Early Mortality in Patients With Takotsubo Syndrome.

BACKGROUND

Initially regarded as a benign acute cardiomyopathy, recent insights have shown that takotsubo syndrome (TTS) carries a prognosis comparable to that of acute coronary syndrome, with a notable impact of inflammatory burden. Given the seasonal variation seen in air pollution, inflammation, and coronary events, we investigated whether chronobiology and inflammation contribute to adverse outcomes.

METHODS AND

RESULTS

Between 2008 and 2020, all consecutive TTS patients were retrospectively included in a multicenter registry. We analyzed the impact of seasonal variation and inflammation on in-hospital events, including acute cardiac failure, cardiogenic shock, and death, as well as 30-day mortality. In-hospital events were identified in 238 (42.6%) patients. Higher rates of in-hospital events and 30-day mortality were observed during winter and spring than in summer and autumn. Multivariate analysis identified the presence of dyspnea on admission (odds ratio [OR] 4.02; 95% confidence interval [CI] 2.61-6.17; P<0.001), a neurological trigger (OR 2.58; 95% CI 1.21-5.50; P=0.014), hyperleukocytosis (OR 1.04; 95% CI 1.02-1.17; P=0.002), and left ventricular ejection fraction at admission (OR 0.98; 95% CI 0.96-1.00; P=0.011) as independent predictors of adverse outcomes.

CONCLUSIONS

In TTS, higher rates of in-hospital events and 30-day mortality were observed during winter and spring. Inflammatory burden and neurological disorders emerged as independent predictors of poor prognosis.