Investigating the 'Diabetes Paradox' in Takotsubo Cardiomyopathy

Area of Science:

• Cardiology
• Endocrinology
• Nephrology

Background:

• Conflicting evidence exists regarding diabetes mellitus (DM) impact on Takotsubo cardiomyopathy (TC) outcomes.
• This study investigates the association between DM and in-hospital outcomes in TC patients.

Purpose of the Study:

• To evaluate the impact of DM on in-hospital mortality, cardiac arrest, cardiogenic shock, and acute kidney injury (AKI) in TC patients.

Main Methods:

• Retrospective analysis of the National Inpatient Sample database (2016-2019) involving 63,155 TC hospitalizations.
• Propensity-score matching (PSM) and multivariable logistic regression were used to assess DM as a predictor of outcomes.
• Primary outcome: in-hospital mortality. Secondary outcomes: cardiac arrest, cardiogenic shock, AKI.

Main Results:

• DM was present in 21.2% of TC patients, who were older with more comorbidities.
• PSM revealed a higher risk of AKI in DM patients (OR, 1.33; 95% CI, 1.16-1.54; p < 0.001).
• No significant differences in mortality, cardiogenic shock, or cardiac arrest were observed between DM and non-DM groups. Comorbidities like CKD, liver disease, and coagulopathy predicted mortality, not DM.

Conclusions:

• DM is associated with an increased risk of AKI in TC patients.
• DM does not significantly affect in-hospital mortality or major adverse cardiac events in TC patients.
• DM appears to have a neutral impact on TC outcomes, warranting further research.