{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T21:58:38Z","timestamp":1792447118437,"version":"4.5.0"},"reference-count":26,"publisher":"American Diabetes Association","issue":"5","license":[{"start":{"date-parts":[[2018,4,20]],"date-time":"2018-04-20T00:00:00Z","timestamp":1524182400000},"content-version":"vor","delay-in-days":64,"URL":"http:\/\/www.diabetesjournals.org\/content\/license"}],"content-domain":{"domain":["diabetesjournals.org"],"crossmark-restriction":true},"short-container-title":[],"published-print":{"date-parts":[[2018,5,1]]},"abstract":"<jats:sec>\n                  <jats:title>OBJECTIVE<\/jats:title>\n                  <jats:p>In view of low prevalence rates, diabetes is discussed as a protective factor for the occurrence of Takotsubo syndrome (TTS). Furthermore, it was associated with improved outcome in a small single-center analysis. Therefore, this study assessed the prevalence and prognostic relevance of concomitant diabetes in TTS.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESEARCH DESIGN AND METHODS<\/jats:title>\n                  <jats:p>A total of 826 patients with TTS were enrolled in an international, multicenter, registry-based study (eight centers in Italy and Germany). All-cause mortality was compared between patients with diabetes and patients without diabetes, and the independent predictive value of diabetes was evaluated in multivariate regression analysis.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>RESULTS<\/jats:title>\n                  <jats:p>The prevalence of diabetes was 21.1% (n = 174). TTS patients with diabetes were older (P &amp;lt; 0.001), were more frequently male (P = 0.003), had a higher prevalence of hypertension (P &amp;lt; 0.001), physical triggers (P = 0.041), and typical apical ballooning (P = 0.010), had a lower left ventricular ejection fraction (P = 0.008), had a higher rate of pulmonary edema (P = 0.032), and had a longer hospital stay (P = 0.009). However, 28-day all-cause mortality did not differ between patients with diabetes and patients without diabetes (6.4% vs. 5.7%; hazard ratio [HR] 1.11 [95% CI 0.55\u20132.25]; P = 0.772). Longer-term follow-up after a median of 2.5 years revealed a significantly higher mortality among TTS patients with diabetes (31.4% vs. 16.5%; P &amp;lt; 0.001), and multivariate regression analysis identified diabetes as an independent predictor of adverse outcome (HR 1.66 [95% CI 1.16\u20132.39]; P = 0.006).<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>CONCLUSIONS<\/jats:title>\n                  <jats:p>Diabetes is not uncommon in patients with TTS, is associated with increased longer-term mortality rates, and is an independent predictor of adverse outcome irrespective of additional risk factors.<\/jats:p>\n               <\/jats:sec>","DOI":"10.2337\/dc17-2609","type":"journal-article","created":{"date-parts":[[2018,2,16]],"date-time":"2018-02-16T01:30:26Z","timestamp":1518744626000},"page":"1084-1088","update-policy":"https:\/\/doi.org\/10.2337\/ada-journal-policies","source":"Crossref","is-referenced-by-count":73,"title":["Prevalence and Prognostic Impact of Diabetes in Takotsubo Syndrome: Insights From the International, Multicenter GEIST Registry"],"prefix":"10.2337","volume":"41","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1957-3741","authenticated-orcid":false,"given":"Thomas","family":"Stiermaier","sequence":"first","affiliation":[{"name":"Cardiology\/Angiology\/Intensive Care Medicine, Medical Clinic II, University Heart Center L\u00fcbeck, and German Center for Cardiovascular Research (DZHK), L\u00fcbeck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Santoro","sequence":"additional","affiliation":[{"name":"Department of Medical and Surgery Sciences, University of Foggia, Foggia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ibrahim","family":"El-Battrawy","sequence":"additional","affiliation":[{"name":"Faculty of Medicine, First Department of Medicine, University Medical Centre Mannheim, University of Heidelberg, and German Center for Cardiovascular Research, Mannheim, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Christian","family":"M\u00f6ller","sequence":"additional","affiliation":[{"name":"Cardiology\/Angiology\/Intensive Care Medicine, Medical Clinic II, University Heart Center L\u00fcbeck, and German Center for Cardiovascular Research (DZHK), L\u00fcbeck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Graf","sequence":"additional","affiliation":[{"name":"Cardiology\/Angiology\/Intensive Care Medicine, Medical Clinic II, University Heart Center L\u00fcbeck, and German Center for Cardiovascular Research (DZHK), L\u00fcbeck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppina","family":"Novo","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andrea","family":"Santangelo","sequence":"additional","affiliation":[{"name":"Cardiology Unit, Biomedical Department of Internal Medicine and Medical Specialties, University of Palermo, Palermo, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Enrica","family":"Mariano","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Rome Tor Vergata, Rome, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesco","family":"Romeo","sequence":"additional","affiliation":[{"name":"Division of Cardiology, University of Rome Tor Vergata, Rome, 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