Co-morbidities in takotsubo syndrome

The incidence of takotsubo syndrome (TTS) is increasing significantly, due to higher awareness and recognition. Although TTS occurs mostly in women, male gender represents an independent predictor of adverse outcome. Outcome may be determined by risk factors, co-morbidities, clinical presentation, and in-hospital or out-of-hospital occurrence. Even in cohorts of patients with a low cardiovascular risk profile, the mortality rate is not significantly different. Among the wide range of co-morbidities reported, psychiatric disorders (i.e. affective and anxiety) are the most common and of the greatest importance. Acute unstable clinical presentation and in-hospital occurrence are both associated with a higher hospital mortality rate. In-hospital presentation is more frequent among men, and is characterized by higher proportions of co-morbidities and acute medical illnesses. Surprisingly, mortality rates of TTS are not significantly different from that of myocardial infarction. Thus, TTS should no longer be simply considered as a benign disease, and co-morbidities deserve high attention.