Article ID: CJ-24-0762
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.
