%0 Journal Article
%T Cardiac rupture as a life-threatening outcome of Takotsubo syndrome: A systematic review.
%A Denicolai M
%A Morello M
%A Del Buono MG
%A Sanna T
%A Agatiello CR
%A Abbate A
%J Int J Cardiol
%V 412
%N 0
%D 2024 Jul 2
%M 38964548
%F 4.039
%R 10.1016/j.ijcard.2024.132336
%X <B>BACKGROUND: </B>Takotsubo syndrome (TS) is a reversible cause of heart failure; however, a minority of patients can develop serious complications, including cardiac rupture (CR).<BR><B>OBJECTIVE: </B>Analyze case reports of CR related to TS, detailing patient characteristics to uncover risk factors and prognosis for this severe complication.<BR><B>METHODS: </B>We conducted a systematic search of MEDLINE and Embase databases to identify case reports of patients with TS complicated by CR, from inception to October 2023.<BR><B>RESULTS: </B>We included 44 subjects (40 females; 4 males) with a median age of 75 (IQR 71-82) years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity. An emotional trigger was present in 15 (34%) subjects and an apical ballooning pattern was observed in all cases (100%). ST-segment elevation was reported in 39 (93%) of 42 cases, with the anterior myocardial segments (37 [88%]) being the most compromised, followed by lateral (26 [62%]) and inferior (14 [33%]) segments. The median time to cardiac rupture was 48 (5-120) hours since admission, with the left ventricular free wall (25 [57%]) being the most frequent site of perforation. Surgery was attempted in 16 (36%) cases, and 28 (64%) patients did not survive.<BR><B>CONCLUSIONS: </B>CR related to TS is a rare complication associated with high mortality and affecting elderly females, specially from White/Caucasian or East Asian/Japanese descent, presenting with anterior or lateral ST-segment elevation, and an apical ballooning pattern. Although data is limited and additional prospective studies are needed, the awareness of this life-threatening complication is crucial to early identify high-risk patients.<BR><B>CONCLUSIONS: </B>Cardiac rupture is a rare complication of Takotsubo syndrome. We conducted a systematic review of cases complicated by cardiac rupture, and we identified 44 subjects (40 females and 4 males) with a median age of 75 (IQR 71-82) years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity, all with an apical ballooning pattern (100%). The median time to cardiac rupture was 48 (5-120) hours since admission, with the left ventricular free wall (25 [57%]) being the most frequent site of perforation. Surgery treatment was attempted in 16 (36%) cases, and 28 (64%) patients did not survive.