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. 2024 Dec;54(12):e14317.
doi: 10.1111/eci.14317. Epub 2024 Oct 13.

Cardiac troponin elevation and mortality in takotsubo syndrome: New insights from the international takotsubo registry

Barbara E Stähli  1 , Matthias Schindler  1 , Victor Schweiger  1   2 , Victoria L Cammann  1 , Konrad A Szawan  1 , David Niederseer  3   4   5 , Michael Würdinger  1 , Alexander Schönberger  1 , Maximilian Schönberger  1 , Iva Koleva  1 , Julien C Mercier  1 , Vanya Petkova  1 , Silvia Mayer  1 , Rodolfo Citro  6   7 , Carmine Vecchione  8   9 , Eduardo Bossone  10 , Sebastiano Gili  11 , Michael Neuhaus  12 , Jennifer Franke  13 , Benjamin Meder  13 , Miłosz Jaguszewski  14 , Michel Noutsias  15 , Maike Knorr  16 , Thomas Jansen  16 , Fabrizio D'Ascenzo  17 , Wolfgang Dichtl  18 , Dirk von Lewinski  19 , Christof Burgdorf  20 , Behrouz Kherad  2 , Carsten Tschöpe  2 , Annahita Sarcon  21 , Jerold Shinbane  22 , Lawrence Rajan  23 , Guido Michels  24 , Roman Pfister  25 , Alessandro Cuneo  26 , Claudius Jacobshagen  27   28 , Mahir Karakas  29   30 , Wolfgang Koenig  31   32 , Alexander Pott  33 , Philippe Meyer  34 , Marco Roffi  34 , Adrian Banning  35 , Mathias Wolfrum  36 , Florim Cuculi  36 , Richard Kobza  36 , Thomas A Fischer  37 , Tuija Vasankari  38 , K E Juhani Airaksinen  38 , L Christian Napp  39 , Rafal Dworakowski  40 , Philip MacCarthy  40 , Christoph Kaiser  41 , Stefan Osswald  41 , Leonarda Galiuto  42 , Christina Chan  43 , Paul Bridgman  43 , Daniel Beug  44   45 , Clément Delmas  46 , Olivier Lairez  46 , Ekaterina Gilyarova  47 , Alexandra Shilova  47 , Mikhail Gilyarov  47 , Ibrahim El-Battrawy  48   49 , Ibrahim Akin  48   49 , Karolina Poledniková  50 , Petr Toušek  50 , David E Winchester  51 , Michael Massoomi  51 , Jan Galuszka  52 , Christian Ukena  53 , Gregor Poglajen  54 , Pedro Carrilho-Ferreira  55 , Christian Hauck  56 , Carla Paolini  57 , Claudio Bilato  57 , Yoshio Kobayashi  58 , Ken Kato  58 , Iwao Ishibashi  59 , Toshiharu Himi  60 , Jehangir Din  61 , Ali Al-Shammari  61 , Abhiram Prasad  62 , Charanjit S Rihal  62 , Kan Liu  63 , P Christian Schulze  64 , Matteo Bianco  65 , Lucas Jörg  66 , Hans Rickli  66 , Gonçalo Pestana  67 , Thanh H Nguyen  68 , Michael Böhm  53 , Lars S Maier  56 , Fausto J Pinto  55 , Petr Widimský  50 , Stephan B Felix  44   45 , Ruediger C Braun-Dullaeus  69 , Wolfgang Rottbauer  33 , Gerd Hasenfuß  27 , Burkert M Pieske  2   70 , Heribert Schunkert  31   32 , Monika Budnik  71 , Grzegorz Opolski  71 , Holger Thiele  72 , Johann Bauersachs  39 , John D Horowitz  68 , Carlo Di Mario  73 , William Kong  74 , Mayank Dalakoti  74 , Yoichi Imori  75 , Luca Liberale  76   77 , Fabrizio Montecucco  76   77 , Thomas Münzel  16 , Filippo Crea  42 , Thomas F Lüscher  78   79 , Jeroen J Bax  80 , Frank Ruschitzka  1 , Jelena R Ghadri  1 , Davide Di Vece  44   45   76 , Christian Templin  44   45   78
Affiliations

Cardiac troponin elevation and mortality in takotsubo syndrome: New insights from the international takotsubo registry

Barbara E Stähli et al. Eur J Clin Invest. 2024 Dec.

Abstract

Background: The clinical relevance of cardiac troponin (cTn) elevation in takotsubo syndrome (TTS) remains uncertain. The present study sought to investigate the role of cardiac troponin (cTn) elevations in mortality prediction of patients with Takotsubo syndrome (TTS).

Methods: Patients enrolled in the International Takotsubo (InterTAK) Registry from January 2011 to February 2020 with available data on peak cTn levels were included in the analysis. Peak cTn levels during the index hospitalization were used to define clinically relevant myocardial injury. The threshold at which clinically relevant myocardial injury drives mortality at 1 year was identified using restricted cubic spline analysis.

Results: Out of 2'938 patients, 222 (7.6%) patients died during 1-year follow-up. A more than 28.8-fold increase of cTn above the upper reference limit was identified as threshold for clinically relevant myocardial injury. The presence of clinically relevant myocardial injury was significantly associated with an increased risk of mortality at 5 years (adjusted HR 1.58, 95% CI 1.18-2.12, p =.002). Clinically relevant myocardial injury was related to an increased 5-year mortality risk in patients with apical TTS (adjusted HR 1.57, 95% CI 1.21-2.03, p =.001), in presence of physical stressors (adjusted HR 1.60, 95% CI 1.22-2.11, p =.001), and in absence of emotional stressors (adjusted HR 1.49, 95% CI, 1.17-1.89, p =.001).

Conclusion: This study for the first time determined a troponin threshold for the identification of TTS patients at excess risk of mortality. These findings advance risk stratification in TTS and assist in identifying patients in need for close monitoring and follow-up.

Keywords: myocardial injury; risk prediction; takotsubo syndrome; troponin.

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References

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