Happy heart syndrome is a rare type of takotsubo syndrome (TTS) and has a higher prevalence of male patients and atypical, nonapical ballooning, compared with the more commonly known broken heart syndrome that is associated with negative emotional stressors, according to a study published June 27 in JACC: Heart Failure.

Thomas Stiermaier, MD, et al., pulled existing data from the multicenter GEIST (German-Italian-Spanish Takotsubo) Registry to analyze the frequency, clinical characteristics and prognostic implications of positive emotional stressors in TTS. Patients were categorized according to their stressors (physical, emotional and unidentifiable) and data compared in patients with pleasant emotional events with patients with negative emotional events.

A total of 2,482 patients with confirmed TTS were included in the study. Within the study population, 855 (34.4%) patients had physical triggers, 910 (36.7%) had emotional triggers and 717 (28.9%) had an unknown trigger before the episode of TTS.  Of patients with emotional triggers, 873 (95.9%) had “broken hearts,” and 37 (4.1%) had “happy hearts.”

Results showed that joyful events provoke TTS in <5% of emotional triggered patients and <2% of all cases. Comparing happy heart syndrome and broken heart syndrome, the prevalence of men was 18.9% vs. 5.0% (p<0.01) and the prevalence of atypical ballooning patterns, particularly midventricular ballooning, was 27.0% vs. 12.5%; p=0.01). However, there was so statistically significant difference for in-hospital complications and long-term outcomes between happy heart and broken heart syndrome despite lower event rates among patients with TTS with pleasant triggers. In the happy hearts and broken hearts groups, the rates were similar for death, pulmonary edema, cardiogenic shock or stroke (8.1% vs. 12.3%; p=0.45) and long-term mortality (2.7% vs. 8.8%; p=0.20).

The authors note this is the largest cohort study of patients with “happy heart” syndrome to date and “expands our knowledge of this rare disease,” but that “additional data are required to evaluate whether the numerically lower event rates in TTS triggered by positive life events would be significant in larger patient cohorts.”

In an accompanying editorial comment, Joseph Adu-Amankwaah, MLS, PhD, notes that despite the study's limitations, several important findings raise additional research questions. He adds that research is needed to clarify the questions this study raises, "which will go a long way to improve the diagnosis and prognosis of TTS in general and illuminate its pathophysiological mechanisms, thereby providing effective treatment strategies."

Clinical Topics: Heart Failure and Cardiomyopathies, Acute Heart Failure

Keywords: Heart Failure, Stroke, Registries, Rare Diseases, Pulmonary Edema, Cohort Studies, Prevalence, Shock, Cardiogenic, Takotsubo Cardiomyopathy

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