title: Comorbidities frequency in Takotsubo syndrome: an international collaborative systematic review including 1109 patients.
abstract: BACKGROUND
  To identify predisposing factors that can result in the onset of takotsubo syndrome, we performed an international, collaborative systematic review focusing on clinical characteristics and comorbidities of patients with takotsubo syndrome.
  
  
  METHODS
  We searched and reviewed cited references up to August 2013 to identify relevant studies. Corresponding authors of selected studies were contacted and asked to provide additional quantitative details. Data from each study were extracted by 2 independent reviewers. The cumulative prevalence of presenting features and comorbidities was assessed. Nineteen studies whose authors sent the requested information were included in the systematic review, with a total of 1109 patients (951 women; mean age, 59-76 years). Evaluation of risk factors showed that obesity was present in 17% of patients (range, 2%-48%), hypertension in 54% (range, 27%-83%), dyslipidemia in 32% (range, 7%-59%), diabetes in 17% (range, 4%-34%), and smoking in 22% (range, 6%-49%). Emotional stressors preceded takotsubo syndrome in 39% of patients and physical stressors in 35%. The most common comorbidities were psychological disorders (24%; range, 0-49%), pulmonary diseases (15%; range, 0-22%), and malignancies (10%; range, 4%-29%). Other common associated disorders were neurologic diseases (7%; range, 0-22%), chronic kidney disease (7%; range, 2%-27%), and thyroid diseases (6%; range, 0-37%).
  
  
  CONCLUSIONS
  Patients with takotsubo syndrome have a relevant prevalence of cardiovascular risk factors and associated comorbidities. Such of associations needs to be evaluated in further studies.
authors: Department of Cardiovascular Sciences, Sapienza University, Rome, Italy. Electronic address: f.pelliccia@mclink.it.
authors: Francesco
authors: F
authors: Pelliccia
authors: Department of Heart and Vessels, Careggi Hospital, Florence, Italy.
authors: Guido
authors: G
authors: Parodi
authors: Department of Cardiovascular Sciences, Sapienza University, Rome, Italy.
authors: Cesare
authors: C
authors: Greco
authors: Department of Heart and Vessels, Careggi Hospital, Florence, Italy.
authors: David
authors: D
authors: Antoniucci
authors: Department of Cardiology, Kantonsspital, CH-St.Gallen, Switzerland.
authors: Roman
authors: R
authors: Brenner
authors: Department of Cardiology, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
authors: Eduardo
authors: E
authors: Bossone
authors: Cardiology Unit, Ospedale Vannini, Rome, Italy.
authors: Luca
authors: L
authors: Cacciotti
authors: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Ancona, Italy.
authors: Alessandro
authors: A
authors: Capucci
authors: Department of Cardiology, University Hospital San Giovanni di Dio e Ruggi d'Aragona, Salerno, Italy.
authors: Rodolfo
authors: R
authors: Citro
authors: Department of Cardiology, Rangueil University Hospital, Toulouse, France.
authors: Clément
authors: C
authors: Delmas
authors: Cardiology and Arrhythmology Clinic, Marche Polytechnic University, Ancona, Italy.
authors: Federico
authors: F
authors: Guerra
authors: Cardiovascular Section, Yale University, New Haven, Conn.
authors: Costin N
authors: CN
authors: Ionescu
authors: Department of Cardiology, Rangueil University Hospital, Toulouse, France.
authors: Olivier
authors: O
authors: Lairez
authors: Cardiology Department, Mount Sinai Medical Center, Miami Beach, Fla.
authors: Maiteder
authors: M
authors: Larrauri-Reyes
authors: Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea.
authors: Pil Hyung
authors: PH
authors: Lee
authors: Hôpital Ambroise Paré, Service de Cardiologie, Centre de Référence des Maladies Cardiaques Héréditaires, Université de Versailles Saint-Quentin, Boulogne, France.
authors: Nicolas
authors: N
authors: Mansencal
authors: L'Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Pisana, Rome, Italy.
authors: Giuseppe
authors: G
authors: Marazzi
authors: Cardiology Department, Mount Sinai Medical Center, Miami Beach, Fla.
authors: Christos G
authors: CG
authors: Mihos
authors: Pôle d'activité medico-chirurgicale Cardiovasculaire, Strasbourg, France.
authors: Olivier
authors: O
authors: Morel
authors: Department of Cardiology and Angiology, University of Giessen, Giessen, Germany.
authors: Holger M
authors: HM
authors: Nef
authors: Cardiovascular Institute, Hospital Clínico San Carlos, Madrid, Spain.
authors: Ivan J
authors: IJ
authors: Nunez Gil
authors: Cardiology Unit, Ospedale Vannini, Rome, Italy.
authors: Ilaria
authors: I
authors: Passaseo
authors: Cardiology Department, Mount Sinai Medical Center, Miami Beach, Fla.
authors: Andres M
authors: AM
authors: Pineda
authors: L'Istituto di Ricovero e Cura a Carattere Scientifico (IRCCS) San Raffaele Pisana, Rome, Italy; Cardiovascular and Cell Sciences Research Institute, St. George's, University of London, London, United Kingdom.
authors: Giuseppe
authors: G
authors: Rosano
authors: Cardiology Department, Mount Sinai Medical Center, Miami Beach, Fla.
authors: Orlando
authors: O
authors: Santana
authors: Department of Cardiology and Angiology, University of Giessen, Giessen, Germany.
authors: Franziska
authors: F
authors: Schneck
authors: Cardiac and Vascular Center, Konkuk University Hospital, Seoul, South Korea.
authors: Bong Gun
authors: BG
authors: Song
authors: Asan Medical Center Heart Institute, University of Ulsan College of Medicine, Seoul, South Korea.
authors: Jae-Kwan
authors: JK
authors: Song
authors: Cardiology Department, Eastern Health Clinical School, Monash University, Victoria, Australia; Department of Cardiology, Austin Hospital, Victoria, Australia.
authors: Andrew W
authors: AW
authors: Teh
authors: Faculty of Medicine, Siriraj Hospital, Mahidol University, Bangkok, Thailand.
authors: Patompong
authors: P
authors: Ungprasert
authors: IRCCS Azienza Ospedaliera, Universitaria San Martino-IST, Genova, Italy.
authors: Alberto
authors: A
authors: Valbusa
authors: Cardiology, University Hospital, Bern, Switzerland.
authors: Andreas
authors: A
authors: Wahl
authors: Department of Cardiovascular of Medicine, Onga Nakama Medical Association, Onga Hospital, Onga, Japan.
authors: Tetsuro
authors: T
authors: Yoshida
authors: Department of Cardiovascular Sciences, Sapienza University, Rome, Italy.
authors: Carlo
authors: C
authors: Gaudio
authors: Cardiovascular and Cell Sciences Research Institute, St. George's, University of London, London, United Kingdom.
authors: Juan Carlos
authors: JC
authors: Kaski
mesh_terms: D002395:Catecholamines / Q000378:metabolism; D014943:Global Health; D006801:Humans; D012307:Risk Factors; D013312:Stress, Physiological; D054549:Takotsubo Cardiomyopathy / Q000150:complications* / Q000453:epidemiology
chemical_list: D002395:Catecholamines
keywords: Acute left ventricular dysfunction; Apical ballooning syndrome; Cardiomyopathy; Takotsubo cardiomyopathy; Takotsubo syndrome