Echocardiographic Correlates of Acute Heart Failure, Cardiogenic Shock, and In-Hospital Mortality in Tako-Tsubo Cardiomyopathy
Echocardiographic Correlates of Acute Heart Failure, Cardiogenic Shock, and In-Hospital Mortality in Tako-Tsubo Cardiomyopathy
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DOI：
10.1016/j.jcmg.2013.09.020
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发表时间：
2014-02-01
影响因子：
14
通讯作者：
Salerno-Uriarte, Jorge
中科院分区：
文献类型：
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作者：
Citro, Rodolfo;Rigo, Fausto;Salerno-Uriarte, Jorge
目的：本研究的目的是确定大队列tako-tsubo心肌病（TIC）患者急性心力衰竭、心源性休克和住院死亡率的临床和超声心动图相关性。背景：尽管长期预后良好，但由于血流动力学不稳定导致的危及生命的并发症可在TIC患者早期发生。方法：纳入Tako-tsubo意大利网络的227例患者（66.2 +/- 12.2岁；女性，90.3%）在入院时接受经胸二维超声心动图检查和短期随访（4.3[4至6]周）。根据是否存在主要不良事件、急性心力衰竭、心源性休克和住院死亡率的组合将患者分为两组。结果发生重大不良事件59例（25.9%）。老年病人的变量> = 75岁(42.4%比23.8%,p = 0.011):左心室(LV)射血分数(35.1 + / - 5.9%和38.4 + / - 4.6%,p < 0.001),壁运动评分指数(1.9 + / - 0.2和1.7 + / - 0.2,p < 0.001), E / E”比率(13.5 + / - 4.3和9.9 + / - 3.3 (E / E的二尖瓣E峰速度和平均比E的速度),p < 0.001), LV流出道梗阻(23.7和8.9%,p = 0.006),肺动脉收缩压(47.4 + / - 12.3毫米汞柱与38.0 + / - 9.2毫米汞柱;P < 0.001)、右心室受累（28.8 vs. 9.5%, P < 0.001）和可逆性中至重度二尖瓣反流（49.1 vs. 11.9%, P < 0.001），组间差异显著，且与不良事件相关。在多因素分析中，左室射血分数（HR: 0.92; 95% Cl: 0.89 ~ 0.95; p < 0.001）、E/ E比值（HR: 1.13; 95% Cl: 1.02 ~ 1.24; p = 0.011）、可逆性中度至重度二尖瓣返流（HR: 3.25; 95% Cl: 1.16 ~ 9.10; p = 0.025）和年龄>= 75岁（HR: 2.81; 95% Cl: 1.05 ~ 7.52; p = 0.039）是主要不良事件的独立相关因素。结论：与临床实践中常用的其他变量相比，超声心动图参数提供了额外的信息，用于识别血液动力学恶化高风险和住院预后差的患者，从而能够及时采取适当的药物治疗和充分的机械支持。[J] journal of Cardiology, 2014;7:119-29] (C) 2014由美国心脏病学会基金会提供
OBJECTIVES The purpose of this study was to determine clinical and echocardiographic correlates of acute heart failure, cardiogenic shock and in-hospital mortality in a large cohort of tako-tsubo cardiomyopathy (TIC) patients.BACKGROUND Despite good long-term prognosis, life-threatening complications due to hemodynannic instability can occur early in TIC patients.METHODS The study population consisted of 227 patients (66.2 +/- 12.2 years of age; females, 90.3%) enrolled in the Tako-tsubo Italian Network, undergoing transthoracic two-dimensional echocardiography on admission and at short-term follow-up (4.3 [4 to 6] weeks). Patients were divided into two groups according to the presence or absence of major adverse events, a composite of acute heart failure, cardiogenic shock, and in-hospital mortality.RESULTS Major adverse events occurred in 59 patients (25.9%). The variables for elderly patients >= 75 years of age (42.4% vs. 23.8%; p = 0.011): left ventricular (LV) ejection fraction (35.1 +/- 5.9% vs. 38.4 +/- 4.6%, p < 0.001), wall motion score index (1.9 +/- 0.2 vs. 1.7 +/- 0.2, p < 0.001), E/e' ratio (13.5 +/- 4.3 vs. 9.9 +/- 3.3 [where E/e' is ratio of mitral E peak velocity and averaged e' velocity], p < 0.001), LV outflow tract obstruction (23.7 vs. 8.9%, p = 0.006), pulmonary artery systolic pressure (47.4 +/- 12.3 mm Hg vs. 38.0 +/- 9.2 mm Hg; p < 0.001), right ventricular involvement (28.8 vs. 9.5%; p < 0.001), and reversible moderate-to-severe mitral regurgitation (49.1 vs. 11.9%; p < 0.001), were significantly different between groups and were associated with adverse events. At multivariate analysis, LV ejection fraction (HR: 0.92; 95% Cl: 0.89 to 0.95; p < 0.001), E/e' ratio (HR: 1.13; 95% Cl: 1.02 to 1.24; p = 0.011), reversible moderate to severe mitral regurgitation (HR: 3.25; 95% Cl: 1.16 to 9.10; p = 0.025), and age >= 75 years (HR: 2.81; 95% Cl: 1.05 to 7.52; p = 0.039) were independent correlates of major adverse events.CONCLUSIONS Echocardiographic parameters provide additional information compared to other variables routinely used in clinical practice to identify patients at higher risk of hemodynamic deterioration and poor in-hospital outcome, allowing prompt institution of appropriate pharmacological treatment and adequate mechanical support. (J Am Coll Cardiol Img 2014;7:119-29) (C) 2014 by the American College of Cardiology Foundation