title: Systematic review and meta-analysis of incidence and correlates of recurrence of takotsubo cardiomyopathy.
abstract: OBJECTIVE
  Takotsubo cardiomyopathy (TTC) is a disorder of myocardial inflammation induced by high catecholamine levels and is associated with acute complications. In the long-term TTC is associated with a risk of single or multiple recurrences, but risk of such occurrences is not clear. We performed a systematic review and meta-analysis to identify and consolidate the evidence on the incidence and clinical correlates of cases of TTC recurrence.
  
  
  METHODS
  A comprehensive search of four major databases (EMBASE, OVID Medline, PubMed and Google Scholar) was performed from their inception to first week of Jan 2014. We included original research studies, recruiting ≥ 5 participants, with ≥ 3 months follow-up, published in English language that reported data on recurrence in patients with TTC.
  
  
  RESULTS
  Out of 298 studies searched, 31 cohorts (1664 TTC patients) were included in the analyses. Out of 74 cases of recurrence, with a mean follow-up of 24.5 months (95% CI, 19.3 to 33 months), extensive recurrence data were available for 23 cases. Cumulative incidence of recurrence was approximately 5% at 6 years. Annual rate of recurrence was approximately 1.5%. Furthermore, 14% of cases had recurrent chest pain and 11% reported dyspnea without definite evidence of recurrent TTC. Discharge medications at index admission included β-adrenoceptor antagonists (BB) in 66.8% and ACE inhibitors (ACEi) and ARB in 67.4%. Recurrence rate was independent of clinic utilization of BB prescription, but inversely correlated (r=-0.45, p=0.016) with ACEi/ARB prescription. Patients with severe TTC at index admission were noted to have more recurrences.
  
  
  CONCLUSIONS
  (1) TTC is associated with only 1-2% annual recurrence rate but substantially greater frequency of ongoing symptoms. (2) ACEi/ARB rather than BB may reduce risk of recurrence.
authors.affiliation: Dept. of Cardiology, Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA 5000, Australia. Electronic address: kjaulakh@gmail.com.
authors.forename: Kuljit
authors.initials: K
authors.lastname: Singh
authors.affiliation: Dept. of Respiratory Medicine, Basil Hetzel Institute, University of Adelaide, Adelaide, SA 5000, Australia.
authors.forename: Kristin
authors.initials: K
authors.lastname: Carson
authors.affiliation: Dept. of Respiratory Medicine, Basil Hetzel Institute, University of Adelaide, Adelaide, SA 5000, Australia.
authors.forename: Zafar
authors.initials: Z
authors.lastname: Usmani
authors.affiliation: The Madison Practice, Suite 6, 25 Hunter St., Hornsby, NSW 2077, Australia.
authors.forename: Gagandeep
authors.initials: G
authors.lastname: Sawhney
authors.affiliation: Dept. of Cardiology, Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA 5000, Australia.
authors.forename: Ranjit
authors.initials: R
authors.lastname: Shah
authors.affiliation: Dept. of Cardiology, Queen Elizabeth Hospital, University of Adelaide, Adelaide, SA 5000, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Horowitz
mesh_terms: D006801:Humans; D015994:Incidence; D016032:Randomized Controlled Trials as Topic / Q000379:methods; D012008:Recurrence; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis* / Q000453:epidemiology*
keywords: Recurrence; Stress cardiomyopathy; Takotsubo cardiomyopathy