ArticleClinical research in cardiology : official journal of the German Cardiac Society2026
Mechanical circulatory support for cardiogenic shock in takotsubo syndrome.
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Victoria L CammannDepartment of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland.
Victor SchweigerDepartment of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland.
Konrad A SzawanDepartment of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland.
Davide Di VeceInternal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, Greifswald, 17475, Germany.
David NiederseerMedicine Campus Davos, Davos, Switzerland.
Michael WürdingerDepartment of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland.
Alexander SchönbergerDepartment of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland.
Maximilian SchönbergerDepartment of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland.
Iva KolevaDepartment of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland.
Julien C MercierDepartment of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland.
Rodolfo CitroHeart Department, University Hospital San Giovanni Di Dio E Ruggi d'Aragona, Salerno, Italy.
Carmine VecchioneDepartment of Vascular Physiopathology, IRCCS Neuromed, Pozzilli, Italy.
Eduardo BossoneDivision of Cardiology, "Antonio Cardarelli" Hospital, Naples, Italy.
Sebastiano GiliCentro Cardiologico Monzino, IRCCS, Milan, Italy.
Michael NeuhausDepartment of Cardiology, Kantonsspital Frauenfeld, Frauenfeld, Switzerland.
Jennifer FrankeDepartment of Cardiology, Heidelberg University Hospital, Heidelberg, Germany.
Benjamin MederDepartment of Cardiology, Heidelberg University Hospital, Heidelberg, Germany.
Miłosz JaguszewskiFirst Department of Cardiology, Medical University of Gdansk, Gdansk, Poland.
Michel NoutsiasDepartment of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, German Heart Center, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Halle (Saale), Germany.
Maike KnorrDepartment of Cardiology, University Medical Center Mainz, Mainz, Germany.
Thomas JansenDepartment of Cardiology, University Medical Center Mainz, Mainz, Germany.
Fabrizio D'AscenzoDivision of Cardiology, Department of Medical Sciences, AOU Città Della Salute E Della Scienza, University of Turin, Turin, Italy.
Wolfgang DichtlUniversity Hospital for Internal Medicine III (Cardiology and Angiology), Medical University Innsbruck, Innsbruck, Austria.
Dirk von LewinskiDivision of Cardiology, Medical University of Graz, Graz, Austria.
Christof BurgdorfHeart and Vascular Centre Bad Bevensen, Bad Bevensen, Germany.
Behrouz KheradDepartment of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany.
Ahmed ElsanhouryDepartment of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany.
Carsten TschöpeDepartment of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany.
Vivian Alice NelkiDepartment of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany.
Annahita SarconSection of Cardiac Electrophysiology, Department of Medicine, University of California-San Francisco, San Francisco, CA, USA.
Jerold ShinbaneKeck School of Medicine, University of Southern California, Los Angeles, CA, USA.
Lawrence RajanTJ Health Partners Heart and Vascular, Glasgow, KY, USA.
Guido MichelsAkademisches Lehrkrankenhausder, Klinik Für Akut- Und Notfallmedizin, St.-Antonius-Hospital gGmbH, RWTH Aachen, Eschweiler, Germany.
Roman PfisterDepartment of Internal Medicine III, Heart Center University of Cologne, Cologne, Germany.
Alessandro CuneoKrankenhaus "Maria Hilf" Medizinische Klinik, Stadtlohn, Germany.
Claudius JacobshagenClinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany.
Mahir KarakasDepartment of Intensive Care Medicine, University Medical Center Hamburg-Eppendorf, Hamburg, Germany.
Wolfgang KoenigDepartment of Cardiology, Technische Universität München, Deutsches Herzzentrum München, Munich, Germany.
Alexander PottMedical Center, University of Ulm, Ulm, Germany.
Philippe MeyerService de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
Marco RoffiService de Cardiologie, Hôpitaux Universitaires de Genève, Geneva, Switzerland.
Adrian BanningDepartment of Cardiology, John Radcliffe Hospital, Oxford University Hospitals, Oxford, UK.
Mathias WolfrumDepartment of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland.
Florim CuculiDepartment of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland.
Richard KobzaDepartment of Cardiology, Kantonsspital Lucerne, Lucerne, Switzerland.
Thomas A FischerDepartment of Cardiology, Kantonsspital Winterthur, Winterthur, Switzerland.
Tuija VasankariHeart Center, Turku University Hospital and University of Turku, Turku, Finland.
K E Juhani AiraksinenHeart Center, Turku University Hospital and University of Turku, Turku, Finland.
L Christian NappDepartment of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Rafal DworakowskiDepartment of Cardiology, King's College Hospital, London, UK.
Philip MacCarthyDepartment of Cardiology, King's College Hospital, London, UK.
Christoph KaiserDepartment of Cardiology, University Hospital Basel, Basel, Switzerland.
Stefan OsswaldDepartment of Cardiology, University Hospital Basel, Basel, Switzerland.
Leonarda GaliutoFondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Christina ChanDepartment of Cardiology, Christchurch Hospital, Christchurch, New Zealand.
Paul BridgmanDepartment of Cardiology, Christchurch Hospital, Christchurch, New Zealand.
Daniel BeugInternal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, Greifswald, 17475, Germany.
Stephan B FelixInternal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, Greifswald, 17475, Germany.
Clément DelmasDepartment of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France.
Olivier LairezDepartment of Cardiology and Cardiac Imaging Center, University Hospital of Rangueil, Toulouse, France.
Ekaterina GilyarovaIntensive Coronary Care Unit, Named After N. Pirogov, Moscow City Hospital# 1 , Moscow, Russia.
Alexandra ShilovaIntensive Coronary Care Unit, Named After N. Pirogov, Moscow City Hospital# 1 , Moscow, Russia.
Mikhail GilyarovIntensive Coronary Care Unit, Named After N. Pirogov, Moscow City Hospital# 1 , Moscow, Russia.
Ibrahim El-BattrawyFirst Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.
Ibrahim AkinFirst Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM) University of Heidelberg, Mannheim, Germany.
Karolina PolednikováThird Faculty of Medicine, Charles University in Prague and University Hospital Královské Vinohrady, Prague, Czech Republic.
Petr ToušekThird Faculty of Medicine, Charles University in Prague and University Hospital Královské Vinohrady, Prague, Czech Republic.
David E WinchesterDivision of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.
Michael MassoomiDivision of Cardiovascular Medicine, Department of Medicine, College of Medicine, University of Florida, Gainesville, FL, USA.
Jan GaluszkaDepartment of Internal Medicine I - Cardiology, University Hospital Olomouc, Olomouc, Czech Republic.
Christian UkenaKlinik Für Innere Medizin III, Universitätsklinikum Des Saarlandes, HomburgSaar, Germany.
Gregor PoglajenAdvanced Heart Failure and Transplantation Center, University Medical Center Ljubljana, Ljubljana, Slovenia.
Pedro Carrilho-FerreiraCenter of Cardiologyof the , Santa Maria University Hospital, CHULN, University of Lisbon, Lisbon School of Medicine, Lisbon Academic Medical Center, Lisbon, Portugal.
Christian HauckKlinik Und Poliklinik Für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany.
Carla PaoliniLocal Health Unit N.8, Cardiology Unit, Arzignano, Vicenza, Italy.
Claudio BilatoLocal Health Unit N.8, Cardiology Unit, Arzignano, Vicenza, Italy.
Yoshio KobayashiDepartment of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
Ken KatoDepartment of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
Iwao IshibashiDepartment of Cardiology, Chiba Emergency Medical Center, Chiba, Japan.
Toshiharu HimiDivision of Cardiology, Kimitsu Central Hospital, Kisarazu, Japan.
Jehangir DinDorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK.
Ali Al-ShammariDorset Heart Centre, Royal Bournemouth Hospital, Bournemouth, UK.
Abhiram PrasadDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Charanjit S RihalDepartment of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.
Kan LiuDivision of Cardiology, Heart and Vascular Center, University of Iowa, Iowa City, IA, USA.
P Christian SchulzeDepartment of Internal Medicine I, University Hospital Jena, Friedrich-Schiller-University Jena, Jena, Germany.
Matteo BiancoDivision of Cardiology, A.O.U San Luigi Gonzaga, Orbassano, Turin, Italy.
Lucas JörgDepartment of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Hans RickliDepartment of Cardiology, Kantonsspital St. Gallen, St. Gallen, Switzerland.
Gonçalo PestanaDepartment of Cardiology, E.P.E, Centro Hospitalar Universitário de São João, Porto, Portugal.
Thanh H NguyenDepartment of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia.
Michael BöhmKlinik Für Innere Medizin III, Universitätsklinikum Des Saarlandes, HomburgSaar, Germany.
Lars S MaierKlinik Und Poliklinik Für Innere Medizin II, Universitätsklinikum Regensburg, Regensburg, Germany.
Fausto J PintoCenter of Cardiologyof the , Santa Maria University Hospital, CHULN, University of Lisbon, Lisbon School of Medicine, Lisbon Academic Medical Center, Lisbon, Portugal.
Petr WidimskýThird Faculty of Medicine, Charles University in Prague and University Hospital Královské Vinohrady, Prague, Czech Republic.
Ruediger C Braun-DullaeusDepartment of Internal Medicine, Cardiology and Angiology, Magdeburg University, Magdeburg, Germany.
Wolfgang RottbauerMedical Center, University of Ulm, Ulm, Germany.
Gerd HasenfußClinic for Cardiology and Pneumology, Georg August University Goettingen, Goettingen, Germany.
Burkert M PieskeDepartment of Cardiology, Charité, Campus Rudolf Virchow, Berlin, Germany.
Heribert SchunkertDepartment of Cardiology, Technische Universität München, Deutsches Herzzentrum München, Munich, Germany.
Monika BudnikDepartment of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Grzegorz OpolskiDepartment of Cardiology, Medical University of Warsaw, Warsaw, Poland.
Holger ThieleDepartment of Internal Medicine/Cardiology, Heart Center Leipzig at Leipzig University, and Leipzig Heart Science, Leipzig, Germany.
Johann BauersachsDepartment of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
John D HorowitzDepartment of Cardiology, Basil Hetzel Institute, Queen Elizabeth Hospital, University of Adelaide, Adelaide, Australia.
Carlo Di MarioStructural Interventional Cardiology, Careggi University Hospital, Florence, Italy.
William KongDepartment of Cardiology, National University Heart Centre, Singapore, Singapore.
Mayank DalakotiDepartment of Cardiology, National University Heart Centre, Singapore, Singapore.
Yoichi ImoriDepartment of Cardiovascular Medicine, Nippon Medical School, Tokyo, Japan.
Laura WehlingDepartment of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany.
Norman MangnerDepartment of Internal Medicine and Cardiology, Herzzentrum Dresden, Technische Universität Dresden, Dresden, Germany.
Ulrich GerkStädtisches Klinikum Dresden, Klinik Für Kardiologie, Dresden, Germany.
Thomas MünzelDepartment of Cardiology, University Medical Center Mainz, Mainz, Germany.
Filippo CreaFondazione Policlinico Universitario A. Gemelli IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy.
Thomas F LüscherCenter for Molecular Cardiology, Schlieren Campus, University of Zurich, Zurich, Switzerland.
Jeroen J BaxDepartment of Cardiology, Leiden University Medical Centre, Leiden, The Netherlands.
Burkhardt SeifertDivision of Biostatistics, Epidemiology, Biostatistics and Prevention Institute, University of Zurich, Zurich, Switzerland.
Jelena R GhadriDepartment of Cardiology, University Heart Center, University Hospital Zurich, and University of Zurich, Zurich, Switzerland.
Christian TemplinInternal Medicine B, University Medicine Greifswald, Ferdinand-Sauerbruch-Straße, Greifswald, 17475, Germany. christian.templin@med.uni-greifswald.de.ORCID http://orcid.org/0000-0003-0287-4193
Funding
No grant is acknowledged in the PubMed record.
Abstract
backgroundCardiogenic shock complicates takotsubo syndrome (TTS) in approximately 10% of cases. The effectiveness of mechanical circulatory support (MCS) for managing cardiogenic shock in TTS remains unknown.
methodsWe assessed outcomes in TTS patients with cardiogenic shock who received MCS compared to medical therapy only by using data from the International Takotsubo Registry. Two independent propensity scores were computed to investigate outcomes of patients with an intra-aortic balloon pump (IABP) vs. medical therapy only (1:2 propensity score matched cohort) and patients with an Impella vs. medical therapy only (1:1 propensity score matched cohort). The primary endpoint was in-hospital mortality and the secondary outcomes included MCS-related complications.
resultsAmong 3740 eligible patients, 309 (8.3%) patients had cardiogenic shock, of whom 112 (36.2%) had MCS and 197 (63.8%) had medical therapy only. After propensity-score matching, the use of an IABP was found to be associated with a lower in-hospital mortality rate than medical therapy only (14.5% vs. 35.5%, P = 0.002), while mortality rates in the Impella group and medical therapy only group were comparable (25.0% vs. 29.2%, P = 0.75). MCS-related complications occurred in 6.0% of the IABP cohort and in 31.3% of Impella cohort.
conclusionActive MCS has been increasingly used for the management of cardiogenic shock in patients with TTS. This observational study could not demonstrate an association with improved mortality with an Impella device, but possibly with an IABP when compared to patients with medical management only. MCS-related complications occurred more frequently in the Impella cohort than in the IABP cohort. Further data are required to confirm results of the present study.
Indexed as
Cardiogenic shockMechanical circulatory supportMortalityTakotsubo syndrome
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