Incidence of ischemic stroke in Takotsubo cardiomyopathy patients: a systematic review and meta-analysis

BACKGROUND: Takotsubo cardiomyopathy (TC) is a cardiomyopathy characterized by temporary ventricular dysfunction, often resembling myocardial infarction. The association between ischemic stroke and TC remains unclear, with unknown true incidence. The objective of this study is to assess the incidence of ischemic stroke in TC patients and its risk factors. METHODS: We carried out a comprehensive search of PUBMED, Google Scholar, PROQUEST, and ScienceDirect databases from their inception to February 2026. Studies reporting the incidence of ischemic stroke in TC patients were included. The quality of studies was evaluated utilizing the Joanna Briggs Institute Critical Appraisal Tools. Statistical analyses were performed using Review Manager and RStudio. RESULTS: = 37%) observed in TC patients without stroke. The mortality risk was higher in TC patients with ischemic stroke (OR7.57; 95% CI 2.70-21.22). Age (MD: 3.04; 95% CI 0.74-5.34), sex (OR0.64; 95% CI 0.53-0.77), diabetes (OR1.73; 95% CI 1.00-3.00), and atrial fibrillation (OR1.87; 95% CI 1.28-2.72) were significantly related to the incidence of ischemic stroke. However, smoking and hypertension showed no significant association with ischemic stroke. CONCLUSIONS: Ischemic stroke in TC patients correlates with an increased mortality rate and is associated with age, sex, and comorbidities, including diabetes and atrial fibrillation. Additional research is necessary to evaluate the possible advantages of anticoagulant therapy in TC patients.