Blood Cell Subtype patterns in Takotsubo Syndrome and acute coronary syndrome: analysis from the GEIST registry

Background and aims: Takotsubo Syndrome (TTS) is a transient left ventricular systolic dysfunction that mimics acute coronary syndrome (ACS) with unclear pathophysiology. This study aims to evaluate blood cell subtypes in TTS and ACS on admission and their impact on outcome. Methods: Admission hemograms of 466 consecutive TTS patients from the German Italian Spanish (GEIST) registry were recorded and, after propensity matching, compared with admission hemograms of 280 ACS patients. Hemogram parameters, including neutrophil lymphocyte ratio (NLR) and lymphocyte monocyte ratio (LMR), were recorded. The primary endpoint was long-term all-cause mortality; the secondary endpoint was in-hospital complications (hemodynamic or electrical instability). Results: Higher monocyte levels and lower LMR were found in TTS compared with ACS patients (0.63 ± 0.3 vs 0.51 ± 0.24 103/μL, p < 0.001; 2.7 (IQR 1.8-3.9) vs 3.2 (IQR 2.2-4.4), p < 0.01). One hundred thirty-three out of 466 (28.5 %) TTS patients experienced in-hospital complications. In multivariate analysis, LVEF (OR 0.92, 95 %CI 0.90-0.95, p < 0.001), physical triggers (OR 2.59, 95 %CI 1.47-4.55, p < 0.01), and NLR (OR 1.06, 95 %CI 1.03-1.09, p < 0.001) were independently associated with in-hospital complications. At multivariate analysis, including age, gender, physical trigger, admission LVEF, hemoglobin levels and NLR (model 1) or LMR (model 2), NLR (OR 1.02, 95 %CI 1.01-1.03, p < 0.01) or LMR (OR = 0.89, 95 %CI 0.81-0.99, p < 0.04) were independent predictors of long-term mortality. NLR levels above the median value and LMR levels below the median value were associated with poor survival in TTS patients (log-rank p < 0.01). Conclusions: TTS is featured by higher levels of monocytes and lower LMR than ACS during hospital admission. NLR and LMR are independent predictors of long-term mortality in TTS.