Journal Article

In-Hospital Adverse Events of Pheochromocytoma-Induced Takotsubo Syndrome: A Literature Review and Cluster Analysis of 172 Cases

Tang, Wenyi, Huang, Hsi, Liu, Tianmin, Xu, Junwei, Guan, Qianglin, Liu, Kan, Xu, Mei, Huang, Yuxi, Pan, Cunxue, Chen, Jian, Xiao, Li, Luo, Liyun

2024

Overview

Background: Pheochromocytoma-induced takotsubo syndrome (Pheo-TTS) significantly increases the risk of adverse events for inpatient. The early identification of risk factors at admission is crucial for effective risk stratification and minimizing complications in Pheo-TTS patients. Methods: We conducted a systematic review combined with hierarchical cluster and feature importance analysis of demographic, clinical and laboratory data upon admission, alongside in-hospital complication data for Pheo-TTS patients. We analyzed cases published in PubMed and Embase from 2 May 2006 to 27 April 2023. Results: Among 172 Pheo-TTS patients, cluster analysis identified two distinct groups: a chest pain dominant (CPD) group (n = 86) and a non-chest pain dominant (non-CPD) group (n = 86). The non-CPD group was characterized by a younger age (44.0 ± 15.2 vs. 52.4 ± 14.4, p < 0.001), a higher prevalence of neurological/psychiatric disorders (53.5% vs. 32.6%), and increased presentation of dyspnea (87.2% vs. 17.4%), pulmonary rales (59.3% vs. 8.1%), and tachycardia (77.9% vs. 30.2%). Additionally, they exhibited more atypical takotsubo syndrome (TTS) imaging phenotypes (55.8% vs. 36.5%, all p < 0.05). The non-CPD group experienced more than a 2-fold increase for in-hospital adverse events compared to the CPD group (70.9% vs. 30.2%, p < 0.001). After adjusting for confounding factors, the absence of chest pain (odds ratio [OR] = 0.407, 95% confidence interval [CI] 0.169–0.979, p = 0.045), the presence of abdominal symptoms (OR = 3.939, 95% CI 1.770–8.766, p = 0.001), pulmonary rales (OR = 4.348, 95% CI 1.857–10.179, p = 0.001), and atypical TTS imaging phenotype (OR = 3.397, 95% CI 1.534–7.525, p = 0.003) remained as independent predictors of in-hospital complications. Conclusions: Clinical manifestations and imaging features at admission help to predict in-hospital complications for Pheo-TTS patients.

• Publisher: IMR Press
• Subject: Abdomen / Cardiac arrhythmia / Cardiomyopathy / Cardiopulmonary resuscitation / Case reports / Catecholamines / chest pain / Cluster analysis / CPR / Diabetes / Dyspnea / Edema / Electrocardiography / Hypertension / Mental disorders / Neuroendocrine tumors / Original Research / Pain / pheochromocytoma / symptoms and signs / takotsubo syndrome