• Luca Arcari, Giacomo Tini, Michela Zuccanti, Giovanni Camastra, Alessandro Cianca, Emanuela Belmonte, Giulio Montefusco, Riccardo Scirpa, Claudia Malerba, Fabrizio Lupparelli, Matteo Sclafani, Viviana Maestrini, Beatrice Musumeci, Emanuele Barbato, and Luca Cacciotti.
• Cardiology Unit, Madre Giuseppina Vannini Hospital, Rome, Italy; Department of Clinical Internal, Anesthesiological and Cardiovascular Sciences, Sapienza University, Rome, Italy. Electronic address: luca.arcari@uniroma1.it.
• Eur. J. Intern. Med. 2025 Feb 1; 132: 848984-89.

Backgroundtakotsubo syndrome (TTS) is an acute heart failure syndrome characterized by a relevant comorbid background, including chronic obstructive pulmonary disease (COPD). However, TTS patients with COPD are still not well characterized.Aimto describe the clinical characteristics and outcomes of patients with TTS and COPD.Methodsn = 440 TTS patients were dichotomized according to the presence of COPD. Endpoint of the study were in-hospital complications (composite of death, major arrhythmias, cardiogenic shock and acute pulmonary edema), TTS recurrence and long-term mortality at follow-up.Resultsmean age of the population was 72±11, 10 % males. COPD prevalence was 16 % (n = 69). On subgroup analysis, patients with COPD were more likely smokers (41 % vs 13 %, p < 0.001), with higher rates of dyspnea and physical triggers at presentation (52 % vs 18 %, p < 0.001 and 52 % vs 32 %, p = 0.001 respectively) and lower left ventricular ejection fraction (36 % vs 39 %, p = 0.035) In-hospital complications were more common in patients with COPD (26 % vs 13 %, p = 0.006), driven by higher rates of acute pulmonary edema (19 % vs 6 %, p < 0.001) and cardiogenic shock (10 % vs 4 %, p = 0.023). At multivariable logistic regression analysis, COPD was independently associated with in-hospital complications occurrence (Odds Ratio 2.10, 95 % CI 1.09-4.05; p = 0.027). At univariable Cox regression analysis COPD was associated with TTS recurrence (Hazard Ratio (HR 9.82, 95 % CI 3.2-30.12; p < 0.001)), at multivariable Cox regression analysis with long-term mortality (HR 2.97, 95 % CI 1.44-6.12; p = 0.003).ConclusionCOPD marks a vulnerable TTS phenotype including higher risk of in-hospital complications, long-term recurrence and mortality.Copyright © 2024 The Author(s). Published by Elsevier B.V. All rights reserved.

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