title: Impact of concomitant atrial fibrillation on the prognosis of Takotsubo cardiomyopathy.
abstract: OBJECTIVE
  Previous studies revealed that patients with Takotsubo cardiomyopathy (TTC) have a higher mortality rate than the general population. Supraventricular tachycardia is a well-known complication of TTC. This study was performed to determine the short- and long-term prognostic impact of atrial fibrillation associated with TTC patients.
  
  
  RESULTS
  Our institutional database constituted a collective of 114 patients diagnosed with TTC from 2003 to 2015. The patients were divided into two groups according to the presence (n = 21, 18.4%) or absence (n = 93, 81.5%) of atrial fibrillation. The endpoint was a composite of in-hospital events (thromboembolic events and life-threatening arrhythmias), all-cause mortality, rehospitalization due to heart failure, stroke, and the recurrence of TTC. The in-hospital mortality, 30-day mortality, and long-term mortality were significantly higher in the atrial fibrillation group. Kaplan-Meier analysis indicated a significantly lower event-free survival rate over a mean follow-up of 3 years in the atrial fibrillation group than that in the non-atrial fibrillation group (log-rank, P < 0.01). In a multivariate cox regression analysis, atrial fibrillation (hazard ratio, HR 2.3, 95% confidence interval, CI: 1.1-4.9, P < 0.05) and EF ≤ 35% (HR 2.0, 95% CI: 1.1-3.8, P < 0.05) were the only independent predictors of a primary endpoint.
  
  
  CONCLUSIONS
  Rates of in-hospital events and short- as well as long-term mortality were significantly higher in TTC patients suffering from atrial fibrillation compared with patients without atrial fibrillation.
authors.affiliation: First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.|DZHK (German Center for Cardiovascular Research), Partner Site, Mannheim, Germany.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: El-Battrawy
authors.affiliation: First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.|DZHK (German Center for Cardiovascular Research), Partner Site, Mannheim, Germany.
authors.forename: Siegfried
authors.initials: S
authors.lastname: Lang
authors.affiliation: First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
authors.forename: Uzair
authors.initials: U
authors.lastname: Ansari
authors.affiliation: First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
authors.forename: Michael
authors.initials: M
authors.lastname: Behnes
authors.affiliation: First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
authors.forename: Dennis
authors.initials: D
authors.lastname: Hillenbrand
authors.affiliation: First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
authors.forename: Katja
authors.initials: K
authors.lastname: Schramm
authors.affiliation: First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
authors.forename: Christian
authors.initials: C
authors.lastname: Fastner
authors.affiliation: First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.|DZHK (German Center for Cardiovascular Research), Partner Site, Mannheim, Germany.
authors.forename: Xiaobo
authors.initials: X
authors.lastname: Zhou
authors.affiliation: First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
authors.forename: Verena
authors.initials: V
authors.lastname: Bill
authors.affiliation: First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
authors.forename: Ursula
authors.initials: U
authors.lastname: Hoffmann
authors.affiliation: First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.|DZHK (German Center for Cardiovascular Research), Partner Site, Mannheim, Germany.
authors.forename: Theano
authors.initials: T
authors.lastname: Papavassiliu
authors.affiliation: First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
authors.forename: Elif
authors.initials: E
authors.lastname: Elmas
authors.affiliation: First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.
authors.forename: Darius
authors.initials: D
authors.lastname: Haghi
authors.affiliation: First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.|DZHK (German Center for Cardiovascular Research), Partner Site, Mannheim, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Borggrefe
authors.affiliation: First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Theodor-Kutzer-Ufer 1-3, 68167 Mannheim, Germany.|DZHK (German Center for Cardiovascular Research), Partner Site, Mannheim, Germany.
authors.forename: Ibrahim
authors.initials: I
authors.lastname: Akin
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001281:Atrial Fibrillation / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D002423:Cause of Death; D016009:Chi-Square Distribution; D016208:Databases, Factual; D018450:Disease Progression; D018572:Disease-Free Survival; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010359:Patient Readmission; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D054549:Takotsubo Cardiomyopathy / Q000150:complications* / Q000401:mortality / Q000503:physiopathology / Q000628:therapy; D013997:Time Factors
keywords: Atrial fibrillation; Mortality; Stroke; Takotsubo cardiomyopathy