Gender-based characterization of Takotsubo syndrome |
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Gender-based characterization of Takotsubo syndrome
Professor (Dr) Ashok Kumar Das, Consultant Physician and Endocrinologist, Pondicherry Institute of Medical Sciences, Pondicherry,  28 May 2022
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Takotsubo syndrome, or stress cardiomyopathy, also commonly referred to as the broken heart syndrome, is an acute heart disease. Clinically, its presentation appears similar to that of acute coronary syndrome with severe left ventricular dysfunction. However, the coronary angiogram is usually normal in patients with Takotsubo syndrome. The transient LV dysfunction is substantial extending beyond the distribution of a single coronary artery, which is not compatible with the rise in cardiac enzymes.1 Takotsubo syndrome is more prevalent in women, particularly those who are postmenopausal, and is triggered by emotional or physical stress. Absence of acute plaque rupture or thrombosis, a recent history of physical or emotional stress, gender are useful clues to the diagnosis of Takotsubo syndrome. 2

Although Takotsubo syndrome is more common in women, but men have worse prognosis, according to a new study published in the Journal of the American College of Cardiology.3

Researchers from Spain, Italy and Germany attempted to describe Takotsubo syndrome based on gender. For this they analyzed data of 2492 patients with TTS sourced from the GEIST (German Italian Spanish Takotsubo) registry. Of these, 2206 were women and 286 were men.

Analysis of data showed that comorbid conditions occurred more frequently in men than in women; among them were diabetes (25% vs 19%), pulmonary diseases (21% vs 15%) and cancer (25% vs 13%). Men with TTS were also younger (69 years vs 71 years). TTS in men was precipitated more often by physical triggers than in women; 55% vs 32%, respectively, whereas in women, emotional triggers were more prevalent; 39% vs 19%, respectively.

A propensity score analysis was also carried out after 1:1 matching of the male and the female participant; each group had 207 patients. Men had higher rates of cardiogenic shock compared to women; 16% vs 6%, respectively. In-hospital mortality rates were also higher in men (8%) than in women (3%). Mortality rate over the long-term was 10% in men and less than 4% in women.

Overall, an independent association was noted between male sex and in-hospital mortality with odds ratio of 2.26 as well as long-term mortality with hazard ratio of 1.83.

In this analysis of patients with Takotsubo syndrome, men comprised just about 11% of the total study population corroborating its rarity in men. The findings of the study show that men had more comorbidities and they also had higher incidences of cardiogenic shock and mortality during hospitalization indicative of poor prognosis. Hence, male patients with Takotsubo syndrome should be closely monitored during their hospital stay. They also require a longer follow-up.


  1. Pelliccia F, et al. Pathophysiology of Takotsubo Syndrome. Circulation. 2017 Jun 13;135(24):2426-2441.
  2. Rawasia WF, et al. Diagnostic dilemma: Takotsubo cardiomyopathy versus acute coronary syndrome. J Invasive Cardiol. 2014 Jun;26(6):E82-4.
  3. Arcari L, et al. Gender differences in Takotsubo syndrome. J Am Coll Cardiol. 2022 May 31;79(21):2085-2093. doi: 10.1016/j.jacc.2022.03.366.
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