Heart & Lung: The Journal of Acute and Critical Care
Volume 40, Issue 5 , Page 472, September 2011

Long-term prognosis of transient left ventricular ballooning syndrome and cancer

Department of Internal Medicine II, University Hospital Schleswig-Holstein Campus Lübeck, Lübeck, Germany

published online 19 August 2010.

Article Outline

 

To the Editor:

It is with great interest that we read the recent article by Song and colleagues1 regarding the long-term prognosis of transient left ventricular ballooning syndrome (Tako-Tsubo cardiomyopathy [TTC]). Most of the reports published thus far suggest a rather benign course of patients with TTC.2 The work by Song and colleagues, however, demonstrates a substantial overall long-term mortality, although cardiac mortality was low. Underlying noncardiac diseases were the only independent predictors of long-term mortality. Notably, 40% of the nonsurvivors died of cancer during follow-up. These data are well in line with recently published observations from Sharkey and colleagues3 and our group, suggesting an association of TTC with malignancies, potentially as a result of paraneoplastic phenomena.4 In addition, long-term prognosis has been shown to be no better than in patients with a recent acute myocardial infarction.

On the basis of the observations reported by Song and colleagues,1 as well as our own data, we strongly suggest the initiation of an international TTC registry with special focus on the prevalence and incidence of cancer to further elucidate the relationship between these diseases. As long as this association cannot be excluded, however, the higher prevalence and incidence of malignancies should prompt physicians to consider performing cancer screening in patients with TTC, as we do at the University Hospital Schleswig-Holstein.

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References 

  1. Song BG, Hahn JY, Cho SJ, et al. Clinical characteristics, ballooning pattern, and long-term prognosis of transient left ventricular ballooning syndrome. Heart Lung. 2010;39:188–195
  2. Elesber AA, Prasad A, Lennon RJ, Wright RS, Lerman A, Rihal CS. Four-year recurrence rate and prognosis of the apical ballooning syndrome. J Am Coll Cardiol. 2007;50:448–452
  3. Sharkey SW, Windenburg DC, Lesser JR, et al. Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy. J Am Coll Cardiol. 2010;55:333–341
  4. Burgdorf C, Kurowski V, Bonnemeier H, et al. Long-term prognosis of the transient left ventricular dysfunction syndrome (Tako-Tsubo cardiomyopathy): focus on malignancies. Eur J Heart Fail. 2008;10:1015–1019

PII: S0147-9563(10)00276-1

doi:10.1016/j.hrtlng.2010.06.005

Heart & Lung: The Journal of Acute and Critical Care
Volume 40, Issue 5 , Page 472, September 2011

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