Clinical Characteristics and Outcomes of Southeast Asian Patients with Takotsubo Syndrome in Singapore

Background: Takotsubo syndrome (TTS) is increasingly recognised to have significant morbidity and mortality. It can be triggered by psychological or physical stressors and frequently mimics an acute coronary syndrome. This study aims to describe the clinical characteristics, outcomes and factors associated with adverse outcomes in southeast-Asian patients with TTS in a single tertiary centre. Methods: A retrospective study was conducted of 68 patients with TTS in a single tertiary cardiology referral centre between January 2010 and December 2017. In-hospital death and cardiogenic shock were analysed as adverse outcomes. The absence of full recovery of left ventricular ejection fraction on follow-up echocardiography was also analysed. Univariate logistic regression was performed to assess for factors associated with adverse outcomes. Results: Cardiogenic shock was noted in 23.5% of patients, and male sex (OR 4.6; 95% CI [1.23–17.26]; p<0.05) and physical triggers (OR 5.13; 95% CI [1.06–24.93]; p<0.05) were associated with increased risk. Of the 5.9% of patients who died during the same admission, all had a physical trigger. Older age at presentation was associated with slightly reduced risk of cardiogenic shock (OR 0.93; 95% CI [0.87–0.99]; p<0.05). Age at onset (OR 1.09; 95% CI [1.01–1.17]; p<0.05) and concomitant ischaemic heart disease (OR 5.02; 95% CI [1.29–19.49]; p<0.05) were associated with absence of full left ventricular ejection fraction recovery. Conclusion: TTS is not benign and has significant adverse outcomes. Male sex and physical triggers were associated with worse in-hospital outcomes, while older age was associated with a slightly reduced risk of cardiogenic shock. Further studies are necessary to evaluate treatment strategies in TTS.