The study, published in the International Journal of Cardiology, stated that cardiac rupture related to Takotsubo syndrome is a rare complication associated with high mortality and affects elderly females, especially of White/Caucasian or East Asian/Japanese descent, presenting with an apical ballooning pattern and anterior or lateral ST-segment elevation.

"Although data is limited and there is a need for additional prospective studies, the awareness of this life-threatening complication is crucial to early identify high-risk patients," the researchers wrote.

Takotsubo syndrome is a reversible cause of heart failure; however, a minority of patients can develop severe complications, including cardiac rupture. Antonio Abbate, University of Virginia, Charlottesville, VA, United States, and colleagues analyzed case reports of CR related to TS, detailing patient characteristics to uncover risk factors and prognosis for this severe complication.

For this purpose, they conducted a systematic search of online databases to identify case reports of patients with TS complicated by CR from inception to October 2023.

The researchers reported the following findings:

• Forty-four subjects (40 females; 4 males) with a median age of 75 years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity.
• An emotional trigger was present in 34% of subjects, and an apical ballooning pattern was observed in all cases (100%).
• ST-segment elevation was reported in 93% of 42 cases, with the anterior myocardial segments (88%) being the most compromised, followed by lateral (62%) and inferior (33%) segments.
• The median time to cardiac rupture was 48 hours since admission, with the left ventricular free wall 57% being the most frequent site of perforation.
• In 36% of cases, surgery was attempted, and 64% of patients did not survive.

The researchers suggest that while cardiac rupture is uncommon in Takotsubo syndrome, healthcare providers should remain vigilant regarding this serious complication to promptly identify high-risk patients. Early detection of cardiac rupture, timely decompression of cardiac tamponade if present, and prompt consideration of cardiac surgery if necessary may reduce mortality in these patients confronting a critical outcome.

"The complete understanding of the pathophysiological mechanism behind cardiac rupture in Takotsubo syndrome remains elusive, and there is a need for additional research to identify ways to reduce mortality rates in this population," the researchers concluded.

Reference:

Denicolai, M., Morello, M., Del Buono, M. G., Sanna, T., Agatiello, C. R., & Abbate, A. (2024). Cardiac rupture as a life-threatening outcome of Takotsubo syndrome: A systematic review. International Journal of Cardiology, 132336. https://doi.org/10.1016/j.ijcard.2024.132336