Clinical outcomes of takotsubo syndrome in patients with cancer: a systematic review and meta-analysis

Takumi Osawa; Kazuko Tajiri; Masaki Ieda; Tomoko Ishizu

doi:10.3389/fcvm.2023.1244808

Clinical outcomes of takotsubo syndrome in patients with cancer: a systematic review and meta-analysis

Front Cardiovasc Med. 2023 Sep 29:10:1244808. doi: 10.3389/fcvm.2023.1244808. eCollection 2023.

Authors

Takumi Osawa^{1

2

3}, Kazuko Tajiri^{3

4}, Masaki Ieda¹, Tomoko Ishizu¹

Affiliations

¹ Department of Cardiology, Institute of Medicine, University of Tsukuba, Tsukuba, Japan.
² Department of Cardiology, Tsukuba Medical Center Hospital, Tsukuba, Japan.
³ Department of Cardiology, National Cancer Center Hospital East, Kashiwa, Japan.
⁴ Tsukuba Life Science Innovation Program (T-LSI), School of Integrative and Global Majors (SIGMA), University of Tsukuba, Tsukuba, Japan.

Abstract

Background: Recent studies suggested a relationship between Takotsubo syndrome (TTS) and malignancy. However, clinical outcomes of TTS associated with cancer have not been assessed completely. This study was aimed to investigate the outcomes of patients with TTS and cancer.

Methods: We performed a systematic review and meta-analysis to evaluate the clinical outcomes of TTS in patients with and without malignancy. We systematically reviewed and analyzed 14 studies (189,210 patients) published in PubMed and Cochrane Library databases until December 2022. The primary outcome was all-cause mortality at the longest follow-up.

Results: The prevalence of current or previous malignancy in patients with TTS was 8.7% (16,461 patients). Patients with TTS and malignancy demonstrated a higher risk of mortality at the longest follow-up than those with TTS alone (odds ratio [OR], 2.41; 95% confidence interval [CI]; 1.95-2.98; P < 0.001). Moreover, cancer was significantly associated with an increased risk of in-hospital or 30-day mortality (OR 2.36; 95% CI, 1.67-3.33; P < 0.001), shock (OR 1.42; 95% CI, 1.30-1.55; P < 0.001), mechanical respiratory support (OR 1.68; 95% CI, 1.59-1.77; P < 0.001), arrhythmia (OR 1.27; 95% CI, 1.21-1.34; P < 0.001), and major adverse cardiac events (OR 1.69; 95% CI, 1.18-2.442; P < 0.001).

Conclusions: This study revealed significant associations between previous or active cancer and an increased risk of all-cause mortality and in-hospital adverse events in patients with TTS.

Keywords: apical ballooning; broken heart syndrome; cardio-oncology; malignancy; onco-cardiology; oncology; stress cardiomyopathy; stress-induced cardiomyopathy.

Publication types

Review

Grants and funding

This work was funded by JSPS KAKENHI (23K07518), SENSIN Medical Research Foundation, and the National Cancer Center Research and Development Fund (2023-A-12).