Long-Term Prognosis in Takotsubo Syndrome: A Comprehensive Approach

Takotsubo syndrome (TTS) is an acute heart failure syndrome featured by a reversible left ventricular systolic dysfunction [1, 2]. Although it affects mainly middle-aged women, about 1 out of 10 patients are men. Most of the patients develop a long-term heart failure phenotype [3], and there is an annual rate of 9.9% of major cardiovascular events [4].Comorbity conditions as cancer [5], renal insufficiency [6], and arrhythmias [7] are highly prevalent in TTS and may influence the long-term prognosis. Several studies showed that males have a worst long-term prognosis than females [8]. Arcari et al. [8] in a large European registry found that males have higher prevalence of comorbid conditions as diabetes mellitus, pulmonary diseases, malignancies, and physical trigger.These data in line to those reported by Palm et al. [9] in the present study. Actually, Palm et al. [9] evaluated also socio-economical features that allow us to evaluate TTS patients in a comprehensive view.In a national registry of 662 Danish TTS patients discharged alive, the authors found that male patients have more comorbidities and a worse long-term outcome. Moreover, they have several socioeconomic features different from females. Indeed, there was a higher prevalence of male TTS patients on disability pension or unemployed (25.3%) compared to women (15.4%) and higher prevalence of low family income group in males (54.4%) versus females (44.9%).Additionally, belonging to the lowest income group, living without another adult, being widowed and on retirement pension were all associated with higher risk of 3-year mortality at the univariate analyses. Interestingly, TTS males were taking more commonly antipsychotics (7.6%) and benzodiazepines/anxiolytics (24.1%) meanwhile females more antidepressants (25.6%). Psychological profile of TTS patients [10] combined with typical neurometabolic brain features [11] are often neglected, but require in selected cases a psychology counselling.These data provide novel insight to this syndrome and show that several features should be recorded during long-term follow-up. A careful evaluation of cardiovascular and non-cardiovascular comorbidities combined with psychological and socioeconomic features of each patient should represent the paramount for a proper long-term management of TTS patients.The authors have no conflicts of interest to declare.No funding is relevant for this study.The authors (F.S., N.D.B.) drafted, reviewed, and wrote the manuscript.