Saved in:
| Main Author: | |
|---|---|
| Format: | Recurso digital |
| Language: | |
| Published: |
Zenodo
2026
|
| Online Access: | https://doi.org/10.5281/zenodo.18517351 |
| Tags: |
Add Tag
No Tags, Be the first to tag this record!
|
| _version_ | 1866901103188115456 |
|---|---|
| author | Camilo Fernández Bravo, MD/ PhD/ FACC |
| author_facet | Camilo Fernández Bravo, MD/ PhD/ FACC |
| contents | <p>✅ Abstract</p> <p> </p> <p>Background:</p> <p>Takotsubo syndrome (TTS) is an acute stress-induced cardiomyopathy characterized by transient left ventricular dysfunction and heterogeneous clinical manifestations. Although TTS predominantly affects women, cardiogenic shock represents a severe and life-threatening complication with significant morbidity and mortality. Sex-specific differences in the pathophysiology, hemodynamic characteristics, and long-term outcomes of TTS complicated by cardiogenic shock remain incompletely understood.</p> <p> </p> <p>Objectives:</p> <p>To investigate sex-related differences in clinical presentation, hemodynamic profiles, management strategies, and long-term outcomes among patients with TTS complicated by cardiogenic shock.</p> <p> </p> <p>Methods:</p> <p>This international multicenter registry included consecutive patients diagnosed with TTS according to contemporary diagnostic criteria and complicated by cardiogenic shock. Advanced hemodynamic profiling was performed using invasive and noninvasive modalities, including pulmonary artery catheterization, echocardiographic assessment of ventricular function, and biomarkers of myocardial injury and systemic inflammation. Patients were stratified by sex and followed for clinical outcomes. The primary endpoint was all-cause mortality at 12 months. Secondary endpoints included in-hospital mortality, requirement for mechanical circulatory support, arrhythmic complications, and heart failure–related rehospitalization.</p> <p> </p> <p>Results:</p> <p>A total of 412 patients with TTS complicated by cardiogenic shock were included, of whom 78% were women. Men presented more frequently with physical stress triggers and a higher burden of comorbid cardiovascular disease, whereas women more commonly exhibited emotional stress triggers (p < 0.01). Hemodynamic assessment revealed that men had lower cardiac index and higher systemic vascular resistance at presentation compared with women (p < 0.05). Men also demonstrated a higher prevalence of right ventricular involvement and more extensive myocardial injury biomarkers. In-hospital mortality was significantly higher in men than in women (28% vs 17%, p = 0.02). At 12 months, men remained at higher risk of all-cause mortality (hazard ratio [HR] 1.67; 95% confidence interval [CI], 1.10–2.54; p = 0.015). Women showed higher rates of recovery of left ventricular systolic function but experienced similar rates of recurrent TTS episodes and heart failure rehospitalization. The use of mechanical circulatory support was more frequent in men, although survival benefit appeared comparable between sexes.</p> <p> </p> <p>Conclusions:</p> <p>Significant sex-specific differences exist in the clinical presentation, hemodynamic profile, and outcomes of TTS complicated by cardiogenic shock. Male sex is associated with greater hemodynamic compromise, increased myocardial injury, and higher mortality risk. These findings highlight the importance of sex-tailored risk stratification and management strategies in patients with severe TTS and underscore the need for further research into sex-related mechanistic pathways and therapeutic approaches.</p> |
| format | Recurso digital |
| id | zenodo_https___doi_org_10_5281_zenodo_18517351 |
| institution | Zenodo |
| language | |
| publishDate | 2026 |
| publisher | Zenodo |
| record_format | zenodo |
| spellingShingle | Sex-Specific Differences in the Pathophysiology, Clinical Presentation, and Long-Term Outcomes of Takotsubo Syndrome Complicated by Cardiogenic Shock: Insights from an International Multicenter Registry with Advanced Hemodynamic Profiling Camilo Fernández Bravo, MD/ PhD/ FACC <p>✅ Abstract</p> <p> </p> <p>Background:</p> <p>Takotsubo syndrome (TTS) is an acute stress-induced cardiomyopathy characterized by transient left ventricular dysfunction and heterogeneous clinical manifestations. Although TTS predominantly affects women, cardiogenic shock represents a severe and life-threatening complication with significant morbidity and mortality. Sex-specific differences in the pathophysiology, hemodynamic characteristics, and long-term outcomes of TTS complicated by cardiogenic shock remain incompletely understood.</p> <p> </p> <p>Objectives:</p> <p>To investigate sex-related differences in clinical presentation, hemodynamic profiles, management strategies, and long-term outcomes among patients with TTS complicated by cardiogenic shock.</p> <p> </p> <p>Methods:</p> <p>This international multicenter registry included consecutive patients diagnosed with TTS according to contemporary diagnostic criteria and complicated by cardiogenic shock. Advanced hemodynamic profiling was performed using invasive and noninvasive modalities, including pulmonary artery catheterization, echocardiographic assessment of ventricular function, and biomarkers of myocardial injury and systemic inflammation. Patients were stratified by sex and followed for clinical outcomes. The primary endpoint was all-cause mortality at 12 months. Secondary endpoints included in-hospital mortality, requirement for mechanical circulatory support, arrhythmic complications, and heart failure–related rehospitalization.</p> <p> </p> <p>Results:</p> <p>A total of 412 patients with TTS complicated by cardiogenic shock were included, of whom 78% were women. Men presented more frequently with physical stress triggers and a higher burden of comorbid cardiovascular disease, whereas women more commonly exhibited emotional stress triggers (p < 0.01). Hemodynamic assessment revealed that men had lower cardiac index and higher systemic vascular resistance at presentation compared with women (p < 0.05). Men also demonstrated a higher prevalence of right ventricular involvement and more extensive myocardial injury biomarkers. In-hospital mortality was significantly higher in men than in women (28% vs 17%, p = 0.02). At 12 months, men remained at higher risk of all-cause mortality (hazard ratio [HR] 1.67; 95% confidence interval [CI], 1.10–2.54; p = 0.015). Women showed higher rates of recovery of left ventricular systolic function but experienced similar rates of recurrent TTS episodes and heart failure rehospitalization. The use of mechanical circulatory support was more frequent in men, although survival benefit appeared comparable between sexes.</p> <p> </p> <p>Conclusions:</p> <p>Significant sex-specific differences exist in the clinical presentation, hemodynamic profile, and outcomes of TTS complicated by cardiogenic shock. Male sex is associated with greater hemodynamic compromise, increased myocardial injury, and higher mortality risk. These findings highlight the importance of sex-tailored risk stratification and management strategies in patients with severe TTS and underscore the need for further research into sex-related mechanistic pathways and therapeutic approaches.</p> |
| title | Sex-Specific Differences in the Pathophysiology, Clinical Presentation, and Long-Term Outcomes of Takotsubo Syndrome Complicated by Cardiogenic Shock: Insights from an International Multicenter Registry with Advanced Hemodynamic Profiling |
| url | https://doi.org/10.5281/zenodo.18517351 |