February 16, 2018
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Diabetes in takotsubo syndrome increases mortality rates

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Adults with takotsubo syndrome and diabetes had higher rates of mortality, hypertension and severely impaired left ventricular ejection fraction compared with those with the cardiomyopathy condition without diabetes, study data show.

Ingo Eitel, MD, of the cardiology/angiology/intensive care medicine department at the University Heart Center Lübeck and the German Center for Cardiovascular Research in Lübeck, Germany, and colleagues evaluated data from the German Italian Stress Cardiomyopathy registry on 826 adults with takotsubo syndrome (median age, 72 years; 83% men) with (n = 174) and without diabetes (n = 652) to determine the prevalence and prognostic effect of diabetes on takotsubo syndrome.

Participants with diabetes were older (P < .001) and had a higher prevalence of hypertension (P < .001) and physical triggers (P = .041) compared with participants without diabetes. Further, participants with diabetes were more likely to have typical apical ballooning (P = .01) resulting in more severely impaired left ventricular ejection fraction (P = .008), a higher rate of pulmonary edema (P = .032) and a longer hospital stay (P = .009).

After a median follow-up of 2.5 years, data were available in 755 participants. There was an all-cause mortality rate of 19.6%. Participants with diabetes had a higher mortality rate compared with participants without diabetes (31.4% vs. 16.5%; HR = 2.02; 95% CI, 1.43-2.84). However, 28-day mortality rates did not significantly differ between the two groups. After adjustment for other clinical risk factors, diabetes continued to be a significant predictor for increased mortality compared with no diabetes (HR = 1.66; 95% CI, 1.16-2.39).

“Diabetes is not uncommon in patients with [takotsubo syndrome] and is associated with significantly elevated longer-term mortality rates,” the researchers wrote. “Furthermore, it is an independent predictor of outcome irrespective of further risk factors. Therefore, diabetes might represent an additional parameter for optimized risk stratification after [takotsubo syndrome].” – by Amber Cox

Disclosures: The authors report no relevant financial disclosures.