Clinical outcomes and left ventricular recovery in patients with solid malignancies developing Takotsubo syndrome: a retrospective cohort study.

Abstract

Takotsubo cardiomyopathy (TTS) is an acute heart failure syndrome characterized by transient left ventricle (LV) systolic dysfunction, often triggered by physical or emotional stress. Although several registries, observational studies, and meta-analyses have demonstrated an association between malignancy and adverse outcomes in Takotsubo syndrome, data describing the interplay between cancer stage, treatment exposure, ventricular recovery, and mortality in patients with solid malignancies remain limited. Material and methods: We retrospectively analyzed adult patients with solid malignancies treated at a Comprehensive Cancer Center between November 2021 and December 2025 who developed Takotsubo syndrome. TTS was diagnosed according to the InterTAK Diagnostic Score together with characteristic echocardiographic findings and, when indicated, additional anatomical or tissue characterization. Demographic characteristics, cancer type and stage, clinical presentation, electrocardiogram and biomarkers findings, imaging results, and outcomes were collected. Primary outcome was all-cause mortality. Secondary outcomes included cause-specific mortality, recovery of left ventricular systolic function, and resumption of cancer therapy. Results: A total of 26 consecutive patients developed TTS during the study period. Median age 64.5 years (IQR 52.2 - 69.5); 61.5% were female. Advanced or metastatic cancer was present in 42.3% of patients. Sepsis occurred in 50.0%, and major cancer-related surgery in 30.8%. The median InterTAK Diagnostic Score was 75.5 (IQR 64.5-80.0); 73.1% of patients had scores ≥70. Overall mortality was 38.5% (10/26), and all deaths were attributed to cancer-related causes; no cardiac-related deaths occurred. Advanced/metastatic disease was associated with higher mortality (80.0% vs. 18.8%, p = 0.015), and all deaths occurred in patients receiving non-curative treatment. In exploratory multivariable analysis, advanced/metastatic cancer was associated with increased odds of death (adjusted OR 11.49, p = 0.021). Follow-up echocardiography was available in 18 patients; all demonstrated normalization of left ventricular systolic function (LVEF ≥50%), with a median time to documented recovery of 10 days (IQR 6-21). Conclusions: Takotsubo cardiomyopathy syndrome in patients with solid malignancies was associated with high cancer-related mortality, whereas left ventricular dysfunction was largely reversible among survivors. Outcomes appeared to be more associated with oncologic disease burden than with cardiac dysfunction.