Original Article

Clinical characteristics and risk factors of in-hospital mortality in patients with Takotsubo syndrome

Vu Hoang Vu1,2https://orcid.org/0000-0001-5482-859X, Thanh Cong Nguyen2,*https://orcid.org/0009-0009-8293-8038, Binh Thi Hai Nguyen2https://orcid.org/0000-0003-0021-3084, Hoa Tran1,2https://orcid.org/0000-0001-8393-6442, Binh Quang Truong1,2https://orcid.org/0000-0003-4973-6919
Author Information & Copyright
1Faculty of Medicine, University of Medicine and Pharmacy at Ho Chi Minh City, Ho Chi Minh City, Vietnam
2Interventional Cardiology Department, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam
*Corresponding author: Thanh Cong Nguyen. Interventional Cardiology Department, University Medical Center Ho Chi Minh City, Ho Chi Minh City, Vietnam. E-mail: thanh.nc@umc.edu.vn

© Copyright 2024 MedPharmRes. This is an Open-Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Received: Jun 08, 2023; Revised: Aug 14, 2023; Accepted: Sep 21, 2023

Published Online: Mar 31, 2024



Takotsubo cardiomyopathy is a condition of transient systolic dysfunction triggered by emotional or physical stress. Nowadays, Takotsubo cardiomyopathy is gaining attention and has been detected more frequently. However, there is no collected data on Vietnamese subjects. This study aims to describe the clinical characteristics of patients diagnosed with Takotsubo cardiomyopathy and determine of rates and independent risk factors for in-hospital mortality.


A retrospective andobservational study was conducted at the University Medical Center Ho Chi Minh City, involved 103 patients diagnosed with Takotsubo cardiomyopathy between January 2015 and June 2022. The diagnosis was made based on the revised Mayo Clinic diagnostic criteria.


The average age of the study population was 71.2±15.3 years, with females accounting for 64.1% of the patients. The most common comorbidities among the patients were hypertension (57.3%), diabetes mellitus (30.1%), ischemic heart disease (15.5%), and chronic obstructive pulmonary disease (15.5%). Acute heart failure was observed in 30.1% of the patients, while ventricular arrhythmias were present in 17.6% of cases. The majority of triggers were attributed to physical factors, including infection (37.9%), respiratory failure (18.4%), postoperative status (3.9%), and acute neurological disease (2.9%). The in-hospital mortality rate was 17.5%, and the independent risk factors were identified as acute heart failure (OR=20.657, 95%CI 2.306–185.008, p=0.007) and respiratory failure (OR=10.397, 95% CI 1.117–96.795, p=0.040).


Takotsubo cardiomyopathy patients have many comorbidities and are often triggered by physical factors. The in-hospital mortality rate is significant, with acute heart failure and respiratory failure identified as independent risk factors.

Keywords: Takotsubo cardiomyopathy; risk factors; hospital mortality; prognosis; hospitalization


Takotsubo cardiomyopathy (also known as stress cardiomyopathy, apical ballooning syndrome, broken-heart syndrome) was first described in Japan in 1990, characterized by transient apical dyskinesia, resembling acute myocardial infarction but without evidence of coronary occlusion or unstable atherosclerotic plaque [1], [2]. The term “Takotsubo” is derived from the Japanese word for an octopus trap, which simulates the image of the ballooning ventricle. Takotsubo cardiomyopathy occurs in 1.7%–2.2% of cases with clinical suspicion of acute coronary syndrome or ST-segment elevation myocardial infarction [3]. The pathogenesis of Takotsubo cardiomyopathy is not fully understood, but some recognized hypotheses include high level of catecholamines, microvascular dysfunction, and coronary artery spasm [4]–[7]. In most cases, left ventricular systolic function recovers in 1–4 weeks [4],[6]–[8]. In-hospital mortality ranges from 0% to 8%, and the risk of major cardiovascular events is considered to be comparable to acute coronary syndromes with independent predictors of older, decreased ejection fraction, increased troponin, physical predisposing factor, apical aneurysm, cardiogenic shock, cardiac arrest at the time of diagnosis [9]–[14]. The recurrence rate is about 1.8% per year [11]. In general, the long-term prognosis is better than that of acute myocardial [15].

The number of patients diagnosed with Takotsubo cardiomyopathy is increasing [16], but most of them are retrospective analyzes and small sample sizes. In Vietnam, there have been case reports but no study has been conducted. This study aims to examine the clinical features of Takotsubo cardiomyopathy, and to determine the rate and independent risk factors of in-hospital mortality in patients diagnosed with this condition. Our aspiration is that our findings will offer valuable contributions and enhance the strategies for diagnosis and treatment of this disease.


2.1. Study design and participants

An observational and retrospective study was conducted at University Medical Center Ho Chi Minh City. The subjects of the were patients older than 18 years of age who were diagnosed and treated for Takotsubo cardiomyopathy between January 2015 and June 2022.

We selected research subjects by searching from the electronic medical record system of University Medical Center Ho Chi Minh City with the keywords “Takotsubo”, and “stress cardiomyopathy”. The Mayo Clinic criteria (2008) used to diagnose Takotsubo cardiomyopathy includes: (1) Transient hypokinesis, dyskinesis or akinesis of the ventricular walls, with or without the apical region, disproportionate to the dominant coronary artery; (2) Absence of significant coronary artery stenosis or acute atherosclerotic lesion; (3) New electrocardiographic abnormalities (either elevated ST-segment and/or T-wave changes) or elevation in cardiac troponin; and (4) Absence of pheochromocytoma or myocarditis [17].

2.2. Sample size

We utilized the sample size formula,

n Z 1 α 2 2 ( 1 p ) p d 2 ,

to estimate a ratio. In this formula, α symbolized a type 1 error, preset at α=0.05, d indicated the estimated error, fixed at d=0.05, and p referred to the estimated proportion. We chose a value of p=5.69%, corresponding to the in-hospital mortality rate derived from a registry analysis of 28,079 patients in the United States who had been diagnosed with Takotsubo cardiomyopathy in 2013–2014 [18]. Consequently, we calculated the minimum number of subjects for the study is 83.

2.3. Data collection

The investigator collected information on demographic, clinical symptoms, laboratory findings, coronary angiography results, treatment and major cardiovascular events occurring during period of hospitalization (all-cause mortality, thromboembolic events, neurological events) according to the available data collection. Comorbidities, including hypertension, coronary artery disease, diabetes mellitus, chronic kidney disease, neuropathy (ischemic stroke and cerebral hemorrhage), and chronic obstructive pulmonary disease, were identified based on the patient’s medical history. Acute heart failure was characterized by symptoms of heart failure, resulting from congestion or reduced cardiac output, with a sudden or unplanned onset, necessitating emergency hospitalization [19]. In Takotsubo syndrome, acute heart failure primarily manifests as left ventricular systolic dysfunction, with potential progression to acute pulmonary edema or cardiogenic shock. Acute respiratory failure was diagnosed based on clinical symptoms, including dyspnea, cyanosis, sweating, tachycardia, hypotension, and impaired consciousness. Additionally, arterial blood gas analysis with PaO2 (arterial partial pressure of oxygen) <60 mmHg and/or pCO2 (arterial partial pressure of carbon dioxide) >45 mmHg under room air conditions was employed to support the diagnosis [20]. The primary clinical outcome was all-cause in-hospital mortality, meticulously recorded through electronic medical records. This encompasses cases of patient death during hospitalization, as well as situations where severe illness prompted relatives to opt for home care, facilitating end-of-life care at home.

2.4. Statistical method

Data were analyzed using SPSS software version 22.0. Qualitative variables are described by frequency and percentages. Chi-squared test or Fisher’s exact test were used to compare proportions. Continuous variables were tested for normal distribution using the Shapiro-Wilk test, presented as mean±SD (for normal distribution) or median with a 25%–75% interquartile range (for non-normal distribution). The mean of the death and surviving groups was compared using the t-test, and the median of the two groups was compared using the Mann-Whitney U test. Logistic regression analysis was used to identify risk factors for in-hospital mortality. The multivariable model was constructed using variables that showed significance at p<0.2 level in relation to in-hospital mortality.

Statistical significance was determined using a two-sided p-value threshold of less than 0.05, reflecting a high level of confidence in the obtained results.

2.5. Ethical considerations

This study did not affect the process of the patient’s diagnosis, treatment and follow-up and approved by the local ethics committee of University Medical Center at Ho Chi Minh City, number 544/HĐĐĐ-ĐHYD.


During the research period, we collected 103 cases diagnosed with Takotsubo cardiomyopathy. The average age of the study population was 71.2, female accounted for 64.1%. Common comorbidities included: hypertension (57.3%), diabetes mellitus (31.2%), chronic ischemic heart disease (15.5%), chronic lung disease (15.5%), cerebrovascular disease (9.7%), cancer (6.8%). Common clinical symptoms were dyspnea (57.3%) and chest pain (36.9%) (Table 1).

Table 1. Baseline characteristics of patients with Takotsubo syndrome
Variables All
 Age (year) 71.2±15.3 69.7±15.8 78.3±10.7 0.030
 Women (n [%]) 66 (64.1) 52 (61.2) 14 (77.8) 0.182
Chronic medical conditions
 Hypertension (n [%]) 59 (57.3) 46 (54.1) 13 (72.2) 0.158
 Chronic ischemic heart disease (n [%]) 16 (15.5) 12 (14.1) 4 (22.2) 0.389
 Heart failure (n [%]) 16 (15.5) 14 (16.5) 2 (11.1) 0.569
 Diabetes mellitus (n [%]) 31 (30.1) 25 (29.4) 6 (33.3) 0.742
 Chronic renal failure (n [%]) 18 (17.5) 12 (14.1) 6 (33.3) 0.051
 Neurological disease (n [%]) 10 (9.7) 7 (8.2) 3 (16.7) 0.273
 COPD (n [%]) 16 (15.5) 12 (14.1) 4 (22.2) 0.389
 Cancer (n [%]) 7 (6.8) 3 (3.5) 4 (22.2) 0.004
 Smoker (n [%]) 9 (8.7) 8 (9.4) 1 (5.6) 0.599
 Alcohol drinking (n [%]) 5 (4.9) 4 (4.7) 1 (5.6) 0.879
General condition of patient at the time of diagnosis
 Chest pain (n [%]) 38 (36.9) 31 (36.5) 7 (38.9) 0.870
 Dyspnea (n [%]) 59 (57.3) 43 (50.6) 16 (88.9) 0.003
 Syncope (n [%]) 1 (1.0) 1 (1.2) 0 (0.0) 0.644
 Heart rate (bpm) 100.7±24.3 96.6±22.5 119.1±23.7 <0.001
 Blood pressure (mmHg) 119.6±24.6 122.7±20.6 124.7±33.5 0.330
 Respiratory rate (bpm) 20.0 (19.0–20.0) 20.0 (19.0–20.0) 20.0 (19.0–23.0) 0.127
 Temperature (C degrees) 37.0 (37.0–37.0) 37.0 (37.0–37.0) 37.0 (37.0–37.4) 0.179
 Weigh (kg) 54.0±11.1 53.6±11.3 55.9±10.5 0.513
 Heigh (cm) 156.5±9.5 156.5±9.8 156.7±8.2 0.962
 BMI (kg/m2) 22.0±4.3 21.9±4.5 22.7±3.2 0.573
 Respiratory failure (n [%]) 19 (18.4) 11 (12.9) 8 (44.4) 0.020
 Acute heart failure 31 (30.1) 20 (23.5) 11 (61.1) 0.002

COPD, chronic obstructive pulmonary disease; BMI, body mass index.

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The median serum concentrations for high-sensitivity troponin T (hs TnT) and NT-ProBNP were 224.0 ng/mL (interquartile range: 61.8–655.0 ng/mL) and 3,511.0 ng/L (interquartile range: 509.0–1,4015.0 ng/L), respectively. Some arrhythmias recorded on electrocardiogram included: atrial fibrillation (12.8%), ventricular tachycardia (17.6%), ST segment elevation (41.2%), ST segment depression (20.0%), T-wave inversion (28.1%). The most affected location of dyskinesia is the apex (76.0%). Coronary angiography results showed that 89.5% of cases were non-obstructive or insignificant stenosis. 28.2% of patients had acute heart failure, of which cardiogenic shock accounted for 21.4% (Table 2). The common triggering factors were infection (37.95%), respiratory failure (18.4%). Psychological stress accounted for only 1.9%. In nearly half of cases, triggering factors was undetermined (43.7%).

Table 2. Subclinical characteristics: analyses, electrocardiography, and imaging
Variables All
Analytical results
 Creatinine (mg/dL) 1.0 (0.8–1.3) 1.0 (0.8–1.3) 1.1 (0.9–1.5) 0.623
 eGFR (mL/min per 1.73 m2) 63.3±28.0 64.9±27.6 55.5±29.4 0.207
 Sodium (mmol/L) 135.0 (131.0–138.0 135.0 (131.0–138.0) 133.0 (129.0–138.0) 0.385
 Potassium (mmol/L) 3.7 (3.3–4.1) 3.7 (3.3–4.1) 3.6 (3.4–4.5) 0.660
 AST (U/L) 44.0 (27.0–68.5) 44.0 (29.0–68.5) 41.0 (26.0–72.5) 0.679
 ALT (U/L) 27.0 (15.5–51.0) 28.0 (15.5–49.5) 24.5 (15.8–57.3) 0.873
 CRP (mg/L)
28.1 (5.8–150.5) 21.5 (5.2–145.3) 119.1 (23.4–215.8) 0.048
 PCT (ng/mL)
0.9 (0.3–3.7) 1.0 (0.3–3.9) 0.8 (0.4–2.0) 0.795
 Hgb (g/L) 122.1±22.9 122.7±20.6 119.1±32.2 0.555
 WBC (G/L) 11.9 (8.1–16.5) 11.9 (8.1–17.0) 13.1 (7.3–14.6) 0.829
 PLT (G/L) 273.2±122.2 268.8±115.8 295.5±152.8 0.482
 hs Tn T (ng/L)
224.0 (61.8–655.0) 214.0 (61.6–563.3) 297.0 (58.4–1,678.5) 0.554
 NT-proBNP (ng/L)
3,511.0 (509.0–14,015.0) 3,550.0 (467.8–12,244.5) 1,886 (575.0–33,586.0) 0.566
Electrocardiography (n=86)
 Atrial fibrillation (n [%]) 11 (12.8) 7 (9.5) 4 (33.3) 0.043
 Ventricular arrhythmia (n [%]) 15 (17.6) 13 (17.6) 2 (16.7) 0.939
 ST elevation (n [%]) 35 (41.2) 29 (39.2) 6 (54.5) 0.334
 ST depression (n [%]) 16 (18.6) 15 (20.2) 1 (8.3) 0.450
 T-wave changes (n [%]) 23 (28.4) 21 (30.0) 2 (18.2) 0.720
Site of wall motion abnormalities in echocardiography (n=87)
 Apical type (n [%]) 73 (84.9) 62 (82.7) 11 (91.7) 0.431
 Basal type (n [%]) 3 (3.4) 3 (4.0) 0 (0.0) 1.000
 Midventricular type (n [%]) 6 (6.9) 6 (8.0) 0 (0.0) 0.590
 Others (n [%]) 18 (18.8) 17 (22.7) 1 (8.3) 0.446
 EF (%) 40.9±12.9 40.7±12.5 41.5±15.7 0.862
Coronary angiography (n=76)
 Normal (n [%]) 46 (60.5) 41 (62.1) 5 (50.0) 0.034
 Insignificant stenosis (n [%]) 22 (28.9) 20 (30.3) 2 (20.0)
 Significant stenosis (n [%]) 8 (10.5) 5 (7.6) 3 (30.0)

eGFR, estimated glomerular filtration rate; AST, aspartate transaminase; ALT, alanine transaminase; CRP, C-reactive protein; PCT, procalcitonin; Hgb, hemoglobin; WBC, white blood cell; PLT, platelet; hs TnT, high-sensitivity troponin T; NT-proBNP, N-terminal pro-B-type natriuretic peptide; EF, ejection fraction.

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The records show that 37.9% of patients received invasive mechanical ventilation, 7.8% of patients received renal replacement therapy. The pharmacologic agents used for acute hemodynamic instability were: dobutamine (23.3%), adrenaline (17.6%), noradrenaline (40.8%). The number of patients who died from all causes in the hospital was 18, accounting for 17.5%. No cases of neurological and thromboembolic events were recorded (Table 3). The results of logistic regression analysis showed that the independent risk factors of death included: acute heart failure (OR=20.657, 95%CI 2.306–185.008, p=0.007) and respiratory failure (OR=10.397, 95% CI 1.117–96.795, p=0.040) (Table 4).

Table 3. Triggering factors and treatment characteristics
Variables All
Triggering factors
 Infection (n [%]) 39 (37.9) 29 (34.1) 10 (55.6) 0.088
 Acute neurological disease (n [%]) 3 (2.9) 2 (2.4) 1 (5.6) 0.442
 Post-surgery (n [%]) 4 (3.9) 3 (3.5) 1 (5.6) 0.542
 Psychological stress (n [%]) 2 (1.9) 2 (2.4) 0 (0.0) 1.000
 Unknown (n [%]) 45 (43.7) 41 (48.2) 4 (22.2) 0.066
 Invasive mechanical ventilation (n [%]) 39 (37.9) 24 (28.2) 15 (83.3) <0.001
 Renal replacement therapy (n [%]) 8 (7.8) 3 (3.5) 5 (27.8) 0.004
 Dobutamin (n [%]) 24 (23.3) 15 (17.6) 9 (50.0) 0.003
 Adrenalin (n [%]) 18 (17.6) 8 (9.4) 10 (55.6) <0.001
 Noradrenalin (n [%]) 42 (40.8) 28 (32.9) 14 (77.8) <0.001
 Nitro glyceryl (n [%]) 7 (6.8) 6 (7.1) 1 (5.6) 1.000
 Diuretic (n [%]) 32 (31.1) 28 (32.9) 4 (22.2) 0.576
 Antiplatelet (n [%]) 32 (31.1) 27 (31.8) 5 (27.8) 0.740
 Statin (n [%]) 45 (43.7) 37 (43.5) 8 (44.4) 0.943
 ACEi (n [%]) 18 (17.5) 16 (18.8) 2 (11.1) 0.434
 ARB (n [%]) 22 (21.4) 21 (24.7) 1 (5.6) 0.072
 ARNI (n [%]) 3 (2.9) 3 (3.5) 0 (0.0) 1.000
 Beta channel blocker (n [%]) 18 (17.5) 17 (20.0) 1 (5.6) 0.186
Duration of treatment, day 10 (4.0–20.0) 13.5 (3.0–21.0) 11.5 (5.5–19.0) 0.790

ACEi, angiotensin converting enzyme inhibitors; ARB, angiotensin receptor blocker; ARNI, angiotensin receptor-neprilysin inhibitor.

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Table 4. Independent risk factors of in-hospital mortality
Variables OR 95% CI p-value
Age 1.059 0.976–1.160 0.218
Female 0.208 0.029–1.472 0.116
Hypertension 1.729 0.234–12.774 0.591
Atrial fibrillation 5.679 0.714–45.202 0.101
Chronic kidney disease 3.362 0.351–32.217 0.293
Cancer 7.860 0.413–149.534 0.170
Infection 3.550 0.562–22.413 0.178
Acute heart failure 20.657 2.306–185.008 0.007
Acute respiratory failure 10.397 1.117–96.795 0.040

OR, odds ratio; CI, confidence interval.

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To our knowledge, this is the first study conducted in Vietnam on Takotsubo cardiomyopathy. The study results demonstrated that Takotsubo cardiomyopathy was prevalent in women and the elderly, often with coexisting medical conditions. Physical factors were the most frequent triggers. Patients diagnosed with Takotsubo cardiomyopathy had a poor prognosis, with a high in-hospital mortality rate, particularly in cases of acute heart failure and respiratory failure.

4.1. Clinical characteristics

According to many previous reports, Takotsubo cardiomyopathy was commonly seen in women, accounting for about 90%, and the average age was 67–70, of which 80% were over 50 years old [11],[21],[22]. However, men accounted for a higher percentage (35.9%) in our study. More recent studies have also shown that the number of men diagnosed with Takotsubo cardiomyopathy is increasing, particularly in the Asian race, and are strongly associated with physical triggers [23]. The increasing prevalence of coronary angiography also results in higher detection of the disease in man compared to before [24].

Diagnosis of Takotsubo cardiomyopathy remains a challenge in practice because of the overlapping manifestations with acute coronary syndromes such as chest pain, elevation of cardiac enzymes and ST-T changes on electrocardiogram [17]. Therefore, coronary and ventricular angiography plays an important role in the diagnosis. 73.7% of patients underwent coronary angiography, the remaining cases were mainly due to clinical conditions not suitable for the procedure (acute renal failure, hemodynamic disorders, coagulopathy...). We used modified Mayo Clinic diagnostic criteria (2008), which is also the most popular diagnostic tool. In most cases, the exclusion of myocarditis and pheochromocytoma is based on clinical signs rather than on imaging and pathology. We recorded 10.5% of patients with significant coronary artery. This rate has fluctuated from 10%–24% in previous reports [11],[25],[26]. The Mayo Clinic diagnostic criteria (2008) have not adequately assessed situations of Takotsubo cardiomyopathy with significant coronary artery stenosis [17]. Some reports have documented the coexistence of Takotsubo cardiomyopathy and acute coronary syndrome, and the acute coronary syndrome itself may be a trigger for Takotsubo cardiomyopathy [26]–[28]. In the setting of regional dyskinesia consistent with coronary artery lesions, cardiac magnetic resonance imaging (MRI) helps differentiate from acute coronary syndromes and myocarditis. Recently, the InterTAK standard was able to overcome the limitations of the Mayo Clinic diagnostic criteria [29].

Common clinical symptoms in patients diagnosed with Takotsubo cardiomyopathy are chest pain, dyspnea, and syncope [12]. Therefore, it is difficult to distinguish from acute coronary syndrome in the initial approach. In our study, the proportion of patients with syncope was less (1.0%), probably due to cognitive impairment and serious acute comorbidities such as pneumonia, infarction. cerebral hemorrhage, post-operative status....

The physical triggers were found more often than the psychological ones, with the highest percentage being infection (37.9%). In fact, it is difficult to fully assess the psychological stress of patients due to severe illness, cognitive disturbances, communication and cultural problems. We also recorded 43.7% cases of unknown trigger. Many other studies have also had similar results, especially men are often associated with physical stress, while women are often associated with mental stress [2],[3],[11].

The median serum concentrations for hs TnT and NT-ProBNP were 224.0 ng/mL and 3,511.0 ng/L, respectively. Most studies found myocardial cell necrosis in Takotsubo cardiomyopathy, but degree of troponin increase was lower compared to acute myocardial infarction (approximately 7.7 times upper limit of normal), and may help predict major cardiovascular events [11]. The concentration of diuretic peptides was increased in 82.9% of cases, often higher than in acute coronary syndromes (approximately 6.12 times the upper limit of normal) [11].

The abnormalities on the electrocardiogram were ST elevation (41.2%), ST depression (20.0%), T wave changes (28.4%), predominantly in the anterior thoracic leads. Regional movement disorder in the apex accounted for the highest rate (76.0%), this is also the classic form of Takotsubo cardiomyopathy. Some other locations were also recorded: the base of the heart (3.1%), the middle of the heart (6.3%), other areas (18.8%). This result was similar to many previous studies [11],[30],[31].

There were 17.6% of patients with ventricular arrhythmias (ventricular tachycardia, torsade de pointes, ventricular fibrillation) and 28.2% of patients with acute heart failure. The incidence of cardiogenic shock was 21.4%, higher than in other studies (about 5%–10%) [11],[32]. These complications are life-threatening in patients with Takotsubo cardiomyopathy and require prompt diagnosis and management.

4.2. In-hospital mortality and independent risk factors

Left ventricular systolic function recovers within 1–4 weeks in most patients with a diagnosis of Takotsubo cardiomyopathy [4],[6]–[8], however, serious complications during hospitalization have been reported similar to acute coronary syndrome [11]. Specifically, the rate of major cardiovascular events (cardiogenic shock, requiring for vasopressors, cardiac arrest, death) related with Takotsubo cardiomyopathy was comparable to that of acute myocardial infarction (38.2% vs. 32.6%) [32]. In-hospital mortality ranges from 0% to 8% [6],[7],[11],[33]. In our study, the all-cause in-hospital mortality rate was 17.5%, higher than previously reported. This may be due to: (1) the high rate of patients with cardiogenic shock (21.4%) and requiring intensive care: invasive mechanical ventilation (37.9%), renal replacement therapy (7.8%), dobutamine (23.3%), noradrenalin (40.8%); (2) a high proportion of males, most of the triggers appearing during hospitalization and are related to physical problems such as infections, stroke, post-surgery, etc. Patients with triggers related to physical stress have a worse prognosis than psychological stress [3],[34]. Furthermore, the analysis results showed that the severe events of Takotsubo cardiomyopathy were mainly due to left ventricular systolic dysfunction and arrhythmias. No cases of cardiac rupture, neurological events or thromboembolic events were recorded.

The independent risk factors of major events from Takotsubo cardiomyopathy were identified as: older age, multiple chronic comorbidities, physical triggers, acute neuropathy, elevated cardiac enzymes >10 times upper limit, ejection fraction <45%, right ventricular dysfunction, cardiogenic shock, arrhythmia [9]–[14],[35]. Some reports have shown that men have higher mortality rates than women [34],[36]. In our study, the independent risk factor for all-cause in-hospital mortality were acute heart failure and respiratory failure. Differences between studies are due to differences in study population characteristics, sample size and statistical methods.

4.3. Limitations

This study had some limitations. Since this study was an observational, retrospective, and non-control study design, it had certain disadvantages. 35.9% of cases did not fully meet the Mayo clinic criteria, myocarditis and pheochromocytoma were ruled out based on clinical manifestations rather than imaging and pathology. The systematic standard was not used to identify trigger factors, especially psychological stress. Finally, the study was conducted in one center;therefore, it was not representative of the general population.


Our study showed that patients diagnosed with Takotsubo cardiomyopathy were mostly female and had many acute and chronic comorbidities. Triggers associated with physical stress were found more frequently than psychological stress. Common complications are acute heart failure and ventricular arrhythmias. In-hospital mortality was high with independent risk factors identified as acute heart failure and respiratory failure at diagnosis.


We would like to express our sincere appreciation to the leadership and medical staff of the Department of Cardiology and Department of Interventional Cardiology at the University Medical Center Ho Chi Minh City. We also acknowledge the contributions of the organizations and functional departments for providing the necessary resources and cooperation to make this research possible.

Funding sources

Not applicable.

Conflict of interest

No potential conflict of interest relevant to this article was reported.

Authors' contributions

Conceptualization: VH Vu, TC Nguyen, BTH Nguyen.

Methodology: VH Vu, TC Nguyen, BTH Nguyen.

Validation: VH Vu, TC Nguyen.

Writing - original draft: TC Nguyen, BTH Nguyen.

Writing - review & editing: VH Vu, TC Nguyen, BTH Nguyen, H Tran, BQ Truong.

Availability of data and material

Upon reasonable request, the datasets of this study can be available from the corresponding author.

Ethics Approval

This study did not affect the process of the patient’s diagnosis, treatment and follow-up and approved by the local ethics committee of University Medical Center at Ho Chi Minh City (number 544/HĐĐĐ-ĐHYD).



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