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Background <p>Cardiogenic 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.</p> Methods <p>We 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.</p> Results <p>Among 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%, <i>P</i> = 0.002), while mortality rates in the Impella group and medical therapy only group were comparable (25.0% vs. 29.2%, <i>P</i> = 0.75). MCS-related complications occurred in 6.0% of the IABP cohort and in 31.3% of Impella cohort.</p> Conclusion <p>Active 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.</p> Graphical Abstract <p></p>

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Mechanical circulatory support for cardiogenic shock in takotsubo syndrome

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  • 发表日期：

    2026年2月2日

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  • Victoria L. Cammann,
  • Victor Schweiger,
  • Konrad A. Szawan,
  • Davide Di Vece,
  • David Niederseer,
  • Michael Würdinger,
  • Alexander Schönberger,
  • Maximilian Schönberger,
  • Iva Koleva,
  • Julien C. Mercier,
  • Rodolfo Citro,
  • Carmine Vecchione,
  • Eduardo Bossone,
  • Sebastiano Gili,
  • Michael Neuhaus,
  • Jennifer Franke,
  • Benjamin Meder,
  • Miłosz Jaguszewski,
  • Michel Noutsias,
  • Maike Knorr,
  • Thomas Jansen,
  • Fabrizio D’Ascenzo,
  • Wolfgang Dichtl,
  • Dirk von Lewinski,
  • Christof Burgdorf,
  • Behrouz Kherad,
  • Ahmed Elsanhoury,
  • Carsten Tschöpe,
  • Vivian Alice Nelki,
  • Annahita Sarcon,
  • Jerold Shinbane,
  • Lawrence Rajan,
  • Guido Michels,
  • Roman Pfister,
  • Alessandro Cuneo,
  • Claudius Jacobshagen,
  • Mahir Karakas,
  • Wolfgang Koenig,
  • Alexander Pott,
  • Philippe Meyer,
  • Marco Roffi,
  • Adrian Banning,
  • Mathias Wolfrum,
  • Florim Cuculi,
  • Richard Kobza,
  • Thomas A. Fischer,
  • Tuija Vasankari,
  • K. E. Juhani Airaksinen,
  • L. Christian Napp,
  • Rafal Dworakowski,
  • Philip MacCarthy,
  • Christoph Kaiser,
  • Stefan Osswald,
  • Leonarda Galiuto,
  • Christina Chan,
  • Paul Bridgman,
  • Daniel Beug,
  • Stephan B. Felix,
  • Clément Delmas,
  • Olivier Lairez,
  • Ekaterina Gilyarova,
  • Alexandra Shilova,
  • Mikhail Gilyarov,
  • Ibrahim El-Battrawy,
  • Ibrahim Akin,
  • Karolina Poledniková,
  • Petr Toušek,
  • David E. Winchester,
  • Michael Massoomi,
  • Jan Galuszka,
  • Christian Ukena,
  • Gregor Poglajen,
  • Pedro Carrilho-Ferreira,
  • Christian Hauck,
  • Carla Paolini,
  • Claudio Bilato,
  • Yoshio Kobayashi,
  • Ken Kato,
  • Iwao Ishibashi,
  • Toshiharu Himi,
  • Jehangir Din,
  • Ali Al-Shammari,
  • Abhiram Prasad,
  • Charanjit S. Rihal,
  • Kan Liu,
  • P. Christian Schulze,
  • Matteo Bianco,
  • Lucas Jörg,
  • Hans Rickli,
  • Gonçalo Pestana,
  • Thanh H. Nguyen,
  • Michael Böhm,
  • Lars S. Maier,
  • Fausto J. Pinto,
  • Petr Widimský,
  • Ruediger C. Braun-Dullaeus,
  • Wolfgang Rottbauer,
  • Gerd Hasenfuß,
  • Burkert M. Pieske,
  • Heribert Schunkert,
  • Monika Budnik,
  • Grzegorz Opolski,
  • Holger Thiele,
  • Johann Bauersachs,
  • John D. Horowitz,
  • Carlo Di Mario,
  • William Kong,
  • Mayank Dalakoti,
  • Yoichi Imori,
  • Laura Wehling,
  • Norman Mangner,
  • Ulrich Gerk,
  • Thomas Münzel,
  • Filippo Crea,
  • Thomas F. Lüscher,
  • Jeroen J. Bax,
  • Burkhardt Seifert,
  • Jelena R. Ghadri,
  • Christian Templin

摘要

Background

Cardiogenic 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.

Methods

We 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.

Results

Among 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.

Conclusion

Active 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.

Graphical Abstract