Two years ago, authors at The Texas Heart Institute and several other institutions published a systematic review of the literature on factors that predict takotsubo cardiomyopathy. This article, which appeared in the journal ESC Heart Failure, was recently named by that journal’s publisher, Wiley, as one of its top downloaded articles.

Recently, Qi Liu, PhD, an assistant research investigator with The Institute’s Molecular Cardiology Research Laboratories, was notified by publisher John Wiley & Sons that an article she had written with her Institute colleagues Su Pan, MD, and Richard A.F. Dixon, PhD, as well as several collaborators from other institutions, was among the most downloaded articles in Wiley’s journal ESC Heart Failure in the 12 months since the article was published in October 2021. The article was titled “Prognostic factors of Takotsubo cardiomyopathy: a systematic review.”

Systematic reviews are more painstaking than typical, narrative reviews, for three reasons. First, the authors must report in detail the databases and search terms that were used to identify articles, such that a reader could reproduce the results of the search. Second, the articles identified in the initial search must be selected or rejected for review according to fixed, predetermined criteria. Third, the articles selected for inclusion in the review must be evaluated and rated on the strength of the evidence they present.

Because systematic reviews can draw meaningful conclusions from the best of the scientific literature on a topic, these articles tend to be highly cited.

The subject of the review, takotsubo cardiomyopathy, is an acute condition that primarily affects the heart’s left ventricle. It is sometimes called “broken heart syndrome” because it can be triggered by severe physical or emotional stress. It is now recognized that takotsubo cardiomyopathy has a mortality rate similar to that of acute coronary syndrome, in which blood flow to the heart is suddenly decreased.

The systematic review analyzed 63 published studies, each of which addressed at least one of two topics: the factors that increase the short- and long-term risk of death in patients with takotsubo cardiomyopathy, and the effectiveness of various drugs in treating this disease. Several factors were found to increase patients’ risk of death: male sex, greater body mass, physical triggers for the disease (such as injuries, acute respiratory failure, and infection), and certain comorbidities like chronic kidney disease, cancer, chronic obstructive pulmonary disease, anemia, and sepsis. The authors also concluded that for many of the types of drugs that have been used to treat patients with takotsubo cardiomyopathy, such as blood pressure medications (angiotensin-converting enzyme inhibitors/angiotensin receptor blockers, beta blockers, and calcium channel blockers) and statins, the evidence supporting their effectiveness was either weak or lacking.

“We think this review has value for both the clinical and the scientific community,” Dr. Liu says. “It informs clinicians regarding the prognosis and treatment of patients with this disease, and it gives researchers many avenues to explore.”

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Read Report

Lu X, Li P, Teng C, Cai P, Jin L, Li C, Liu Q, Pan S, Dixon RAF, Wang B. Prognostic factors of Takotsubo cardiomyopathy: a systematic review. ESC Heart Fail. 2021 Oct;8(5):3663-3689. doi: 10.1002/ehf2.13531.

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News Story By Stephen N. Palmer, PhD, ELS

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