Exploring sex-specific clinical features in Chinese patients with Takotsubo syndrome

Background: Takotsubo syndrome (TTS) is considered as a transient acute heart failure syndrome predominant in females. However, data on Chinese TTS patients are limited. Therefore, this study aimed to investigate the clinical characteristics of Chinese TTS patients, identify prognostic markers. Methods: A total of 258 TTS patients were enrolled. Data on clinical characteristics and in-hospital major adverse cardiovascular events (MACE) were collected and analyzed. The latter included severe heart failure, shock, malignant arrhythmia, and death. Results: The average age of TTS patients was 59.3 ± 19.2 years. Female patients accounted for 68.9%. MACE occurred in 41.4% of patients during hospitalization. Compared with males, female TTS patients were older, had more emotional causes, higher proportion of typical apical ballooning type, higher LVEF, more prolonged QTc, as well as lower early repolarization (ER) and MACE ratio (35.6% vs. 53.8%, P = 0.006). Compared to female patients with emotional triggers, those female patients with physical triggers are younger, have a lower proportion of chest pain and abnormal ECG, but are more prone to experiencing MACE. Physical triggers, CKMB, LVEF, non-apical ballooning, ER pattern and premature ventricular beats were independent predictors of in-hospital MACE, whereas age, physical triggers and platelet count were specifically independent predictors for female TTS cases. Conclusions: Chinese TTS patients demonstrate unique clinical characteristics and in-hospital outcomes. Apart from the well-known fact that male with TTS has high-risk phenotype, our study newly identifies that TTS females with younger age or physical triggers also have worse prognosis, which warrants close attention and follow-up.