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Takotsubo Syndrome in Patients with History of Malignancy: Clinical Features and Follow-up
Session:
Posters (Sessão 5 - Écran 7) - Miocardiopatia de stress
Speaker:
Ana Isabel Pinho
Congress:
CPC 2023
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.7 Myocardial Disease - Other
Session Type:
Pósters Electrónicos
FP Number:
---
Authors:
Ana Isabel Pinho; Cátia Oliveira; Luís Daniel Santos; André Cabrita; Catarina Amaral Marques; Ana Filipa Amador; Catarina Martins da Costa; João Calvão; Miguel Martins de Carvalho; Ricardo Alves Pinto; Tânia Proença; Paula Dias; Gonçalo Pestana; Carla Sousa; Filipe Macedo
Abstract
<p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif">Background: The numerous effects of malignancy and therapies on the heart are under increasing discussion with the advent of Cardio-oncology. Several studies have described the occurrence of Takotsubo Syndrome (TTS) in the setting of malignancy, however there is limited data on the impact of history of malignancy on clinical outcomes of patients (pts) with TTS. </span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif">Aim: To investigate differences in clinical features, outcomes and long-term follow-up in TTS pts with and without history of malignancy. </span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif">Methods: We collected a retrospective cohort of 142 TTS pts admitted to our hospital, defined according to the revised Mayo Clinic diagnostic criteria. Pts were categorized into 2 groups based on the presence or absence of history of malignancy, active or in the past. Kaplan-Meier survival analysis was used to assess long-term mortality. </span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif">Results: History of malignancy was observed in 26 (18%) pts, the majority cured. The most frequent types of malignancy were thyroid (27%), gynecologic (23%), breast (15%) and bowel (12%) cancer.</span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif">No differences were observed between TTS pts with and without malignancy regarding age (66.9±14.3 years vs 67.2±11.9 years, P=0.906) or gender (96.2% vs 91.4% women, P=0.689). Prevalence of cardiovascular risk factors was comparable between the 2 groups (P=0.858) as well as psychiatric, neurologic, renal and autoimmune comorbidities. </span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif">TTS pts with history of malignancy had significant higher levels of brain natriuretic peptides (592 pg/mL, IQR 258-1008 vs 227 pg/mL, IQR 121-758, P=0.038); troponin I peak levels during hospitalization were similar (P=0.943). No differences were observed regarding the median duration of hospitalization, presence of triggers and systolic disfunction.</span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:Calibri,sans-serif">In-hospital complications were comparable between TTS pts with and without history of malignancy (54% vs 46%, P=0.451). While in-hospital mortality did not differ between the 2 groups (3.8% vs 1.7%, P=0.457), 5-year survival analysis showed a higher mortality in patients with history of malignancy (P=0.029, figure 1), including cardiovascular death. History of malignancy conferred a higher risk of 5-year mortality (HR 3.88, 95% CI 1.04-14.48, P=0.043). </span></span></p> <p style="text-align:justify"><span style="font-size:14px"><span style="font-family:"Calibri",sans-serif">Conclusion: The relationship between TTS and cancer is challenging and questions remain as to whether the worse prognosis is related to TTS episodes, malignancy or even effects of treatment. We found a substantial prevalence of history of malignancy in TTS pts and a higher long-term mortality in this subgroup, suggesting that factors associated with malignancy can impact TTS outcomes.</span></span></p>
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