Possible association between Takotsubo cardiomyopathy, sepsis, and diabetes mellitus: a still open question.

Letter (provided by the authors): The association between diabetes mellitus (DM) and TTC has been matter of several investigations. Pelliccia et al, evaluating a series of 19 studies (1,109 patients), concluded that patients with TTC have a relevant prevalence of cardiovascular risk factors and associated comorbidities. Obesity was present in 17% of patients, hypertension in 54%, smoking in 22%, dyslipidemia in 32%, and DM in 17% . A recent review of papers accessed in PubMed to evaluate the prevalence of DM in TTC patients (959 studies, 33,894 patients), confirmed an overall prevalence of 16.8%. A gender difference for mortality has been confirmed also very recently. An analysis of all patients ≥18 years of age diagnosed with TTC identified in the Nationwide Inpatient Sample (NIS) 2009-2010 database, found that the total in-hospital mortality rate was 2.4%, with a higher mortality in men (4.8%) than in women (2.1%). Sepsis (9 vs. 4.2%) was more prevalent in men with an increased prevalence of other critical illness. Further studies are needed on this relatively infrequent, but potentially harmful relationship