Cancer may be linked to an increased risk of death and prehospitalization in patients with broken heart syndrome, according to research presented by Santoro et al at the 2018 European Society of Cardiology Congress.
Study author Francesco Santoro, MD, of the University of Foggia, Italy, said, “In our study, patients with broken heart syndrome were twice as likely to die or be readmitted to hospital within 3 years if they had previous or current cancer than if they did not. Patients with broken heart syndrome and cancer need strict monitoring at follow-up.”
Broken Heart Syndrome
Broken heart syndrome—also called takotsubo cardiomyopathy—is a type of heart failure that occurs suddenly and goes away within days or weeks. Increased levels of stress hormones are thought to be one of the main drivers. Symptoms are similar to a heart attack and include sudden chest pain and shortness of breath. Around 30% of cases of takotsubo cardiomyopathy are due to emotional triggers, such as the death of a spouse, anger, financial problems, or happy life events. Around 40% of patients have a physical trigger, such as surgery, whereas in 30%, the trigger is unknown. Prior studies have suggested that cancer may be a physical trigger.
The current study investigated the association between cancer and poor outcomes in patients with takotsubo cardiomyopathy by combining the results of three published studies on this topic in a meta-analysis. The researchers looked at adverse events that occurred while patients were in the hospital with takotsubo cardiomyopathy (life-threatening arrhythmia, cardiogenic shock, thromboembolism, respiratory support) as well as all-cause death and rehospitalization for cardiovascular disease during the first 3 years after discharge from the hospital.
A total of 554 patients admitted to the hospital with takotsubo cardiomyopathy were included in the analysis. One in five patients had previous or current cancer (113 patients; 20%). Gastrointestinal cancers were the most frequent (23%), whereas nervous system and urinary cancers were the rarest (3% for each). Patients who had past or existing cancer were of a similar age to those who never had cancer.
When the researchers examined the risk of in-hospital and postdischarge adverse events together, they found that patients with takotsubo cardiomyopathy with past or existing cancer had a significantly higher risk of clinical events than those without cancer (risk ratio [RR] = 1.82, 95% confidence interval [CI]: 1.37–2.42, P < .01). When evaluated separately, the risk of events after discharge was twofold higher in the cancer group than in the cancer-free group (RR = 2.08, 95% CI: 1.50–2.87, P < .01). There was a trend toward a higher risk of in-hospital events in the cancer group, but it was not statistically significant (RR = 1.30, 95% CI: 0.74–2.29, P = .36).
Dr. Santoro said, “We found that takotsubo cardiomyopathy patients who had ever had cancer were at greater risk of adverse events, particularly after discharge from hospital. More research is needed to clarify the reasons for this. These patients may benefit from standard therapy for heart failure, especially an angiotensin-converting enzyme inhibitor or angiotensin receptor blocker.”
Dr. Santoro noted a limitation of the study was that there was no control group of individuals without takotsubo cardiomyopathy.
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