Background: Inflammatory diseases may have important roles in the development of Takotsubo syndrome (TTS). However, the clinical profile and outcomes of patients with TTS triggered by inflammatory diseases have rarely been studied.
Aim: This study aimed to investigate the prevalences of inflammatory triggers in patients with TTS and describe the clinical characteristics of such patients. Additionally, this study compared the clinical outcomes of patients with TTS triggered by inflammatory diseases to the clinical outcomes of patients with TTS triggered by other mechanisms.
Methods and results: One hundred thirty-two patients were enrolled into the single-centre Takotsubo Registry between October 2013 and May 2021. According to the TTS trigger mechanism, patients were divided into three groups: I (emotional trigger, 34 patients; 31.5%), II (non-inflammatory physical trigger, 36 patients; 33.3%), and III (inflammatory trigger, 38 patients: 35.2%). A clear trigger was not identified in 24 (18.1%) patients.
There were no significant differences among groups in terms of clinical characteristics, electrocardiography (ECG) findings, or imaging results (ejection fraction in echocardiography and type of TTS according to ventriculography). The natriuretic peptide (NT-proBNP) level was higher in group III (11320.3 ± 12538.0 ng/l) than in group I (4641.4 ± 5366.4 ng/l; p < 0.04); it did not significantly differ from the level in group II (13366.1 ± 12934.2 ng/l; p = 0.54). Patients in group I had the most favourable outcomes in terms of in-hospital survival and an absence of cardiac events. The rates of adverse cardiac events and in-hospital mortality did not significantly differ between groups II and III (22.2% vs. 15.8%; p = 0.48).
Conclusion: Almost one-third of all patients with TTS in this study had an inflammatory trigger. The clinical characteristics and outcomes were comparable between patients with TTS caused by inflammatory triggers and patients with other physical triggers. The best clinical outcomes were observed in patients with TTS caused by an emotional trigger.