Clinical Characteristics and Outcomes of Takotsubo Syndrome Patients with Gastrointestinal Diseases: A Systematic Review

Background: Takotsubo syndrome (TTS) is identified by its acute and transient impairment of left ventricular systolic function. Although recent research has highlighted occurrences of TTS among individuals with gastrointestinal diseases (GI diseases), comprehensive and systematic investigations focusing on this patient demographic are still scarce. Methods: This retrospective study analyzed case reports and series that documented an association between gastrointestinal diseases (GI diseases) and Takotsubo syndrome (TTS). We conducted comprehensive searches across PubMed, Embase, and the Cochrane Database to identify relevant cases. Results: In patients with gastrointestinal-induced Takotsubo syndrome (GI-TTS), the primary reasons for admission were pancreatitis (15.48 %), liver failure (10.71 %), bowel obstruction (5.95 %) and liver cirrhosis (5.95 %). It is noteworthy that the main triggers for Takotsubo syndrome are surgeries related to gastrointestinal diseases (29.76 %), including liver transplantation (15.48 %) and cholecystectomy (2.38 %). Dyspnea (45.71 %) was the most common symptom, followed by abdominal pain (35.71 %) and chest pain (34.29 %). The apical type was the most frequent TTS variant (81.25 %). Compared with the All-TTS cohort, GI-TTS patients were younger, and had a lower proportion of women (69.05 % vs. 89.77 %, P < 0.001). GI-TTS patients had higher ventilation use and lower usage of beta-blockers, ACEI/ARBs, aspirin, and statins, while catecholamine use was more prevalent. Conclusions: The study underscores the potential of gastrointestinal diseases and their treatments to trigger TTS, often presenting atypical clinical features compared to TTS of all types. Given these differences, an elevated level of clinical vigilance is imperative for the timely diagnosis of TTS in patients with gastrointestinal conditions.