Background: Takotsubo syndrome (TTS) can be caused by a large variety of psycho-physical triggers, and several cases are related to either an overt or occult malignancy, as shown in retrospective studies and single reports.
Purpose: To evaluate the overall prevalence of cancer in takotsubo patients and to compare clinical outcomes with cancer-free takotsubo subjects in a metanalysis study.
Methods: In December 2017 a Pubmed and ResearchGate systematic screening was conducted for retrospective studies concerning this topic. Works with no comparison group were excluded. Outocomes of interest were in-hospital events (life threatening arrhythmias, cardiogenic shock, thromboembolism, respiratory support) and events at follow-up (all-cause mortality, re-hospitalization for cardiovascular disease) assessed with Mantel-Haenszel pooled risk ratios (RRs) and 95% confidence intervals (CIs). Furthermore, an analysis of the most frequent occurred neoplasms as well as the time to the diagnosis after the index event was performed.
Results: Three studies were included with a total of 554 patients. The prevalence of history of current or previous malignancy among patients admitted with TTS was 20% (113 subjects). When compared to non-cancer patients, patients with current or previous disease showed a statistically significant relative risk of clinical events (both in-hospital and at follow-up) (RR 1.82, 95%, 1.37–2.42, p<0.0001) (Figure 1). The risk of in-hospital events was higher in cancer group, although not significant (RR 1.30, 95% CI, 0.74–2.29, p=0.36), whereas events at follow-up were statistically more probable (RR 2.08, 95% CI, 1.50–2.87, p<0.00001). Nearly 17% of patients experienced subsequent tumors or relapses within 3.2±1.3 years. Additionally, gastrointestinal cancers were the most frequent associated neoplasms (23%), while nervous system and urinary cancer were the rarest (3% for each).
Conclusion: History of cancer carries an increased risk of adverse events in TTS patients; a careful follow-up may be reccomended in TTS with history of cancer.