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Takotsubo syndrome in patients with malignancies: a metanalysis.

Session Cardiovascular events in malignancies: from prediction to prevention

Speaker Francesco Santoro

Congress : ESC Congress 2018

  • Topic : cardiovascular disease in special populations
  • Sub-topic : Cardio-Oncology
  • Session type : Rapid Fire Abstracts
  • FP Number : 6133

Authors : N Tarantino (Foggia,IT), F Santoro (Hamburg,DE), F Guastafierro (Foggia,IT), V Di Terlizzi (Foggia,IT), SE Formica (Foggia,IT), R Ieva (Foggia,IT), G D'arienzo (Foggia,IT), PL Pellegrino (Foggia,IT), LC Ziccardi (Foggia,IT), M Di Biase (Foggia,IT), ND Brunetti (Foggia,IT)

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Authors:
N. Tarantino1 , F. Santoro2 , F. Guastafierro1 , V. Di Terlizzi1 , S.E. Formica1 , R. Ieva1 , G. D'Arienzo1 , P.L. Pellegrino1 , L.C. Ziccardi1 , M. Di Biase1 , N.D. Brunetti1 , 1University of Foggia, Department of Medical and Surgical Sciences - Foggia - Italy , 2Asklepios Clinic St. Georg - Hamburg - Germany ,

Citation:
European Heart Journal ( 2018 ) 39 ( Supplement ), 1271

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.

Figure 1

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