Prognostic implications of pre-existing medical comorbidity in Takotsubo cardiomyopathy.
Prognostic implications of pre-existing medical comorbidity in Takotsubo cardiomyopathy.
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DOI：
10.1007/s00380-020-01713-x
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发表时间：
2021-04
影响因子：
1.5
通讯作者：
Horwich T
中科院分区：
文献类型：
--
作者：
Nayeri A;Yuen A;Huang C;Cardoza K;Shamsa K;Ziaeian B;Wells QS;Fonarow G;Horwich T
Takotsubo心肌病（TC）与显著的短期发病率和死亡率相关。已经确定了几个不良结局的风险因素;然而，TC中预先存在的合并症的预后影响尚不清楚。我们试图评估合并症与TC短期结局的关系。我们对2005年至2018年期间在两家学术三级医院诊断为TC的成人受试者进行了回顾性观察研究。使用Charlson合并症指数（CCI）估计医疗合并症的总体负担。多变量逻辑回归用于检验CCI与30天死亡率和严重休克的独立相关性。采用多变量Poisson回归分析评估CCI与住院时间的相关性。在研究期间，538例受试者被诊断为TC。所有受试者的中位CCI评分为2（IQR 1-4）。在TC的物理触发的受试者中，中位CCI评分为2（IQR 1-4），而TC的非物理触发的受试者中位CCI评分为1（IQR 0-1）（P < 0.001）。76例（14%）受试者在索引诊断后30天内死亡，185例（34%）受试者发生重度休克。中位住院时间为7天（IQR 3-14天）。在多变量logistic回归分析中，CCI与30天死亡率或严重休克无关。多因素Poisson回归分析显示，CCI（IRR 1.17，95% CI 1.16-1.18，P < 0.001）与住院时间相关。既存合并症的负担增加与30天死亡率或指数就诊时严重休克无关，但与TC诊断后住院时间延长相关。
Takotsubo cardiomyopathy (TC) is associated with significant short-term morbidity and mortality. Several risk factors for poor outcomes have been identified; however, the prognostic implications of pre-existing comorbidity in TC are poorly delineated. We sought to assess the association of aggregate pre-existing comorbidity with short-term outcomes in TC. We performed a retrospective observational study of adult subjects diagnosed with TC at two academic tertiary care hospitals between 2005 and 2018. Overall burden of medical comorbidity was estimated using the Charlson comorbidity index (CCI). Multivariable logistic regression was used to test for independent association of CCI with 30-day mortality and severe shock at index presentation. Multivariable poisson regression was performed to assess the association of CCI with duration of hospitalization. Five-hundred and thirty-eight subjects were diagnosed with TC during the study period. The median CCI score of all subjects was 2 (IQR 1–4). Among subjects with physical triggers of TC, the median CCI score was 2 (IQR 1–4) compared to a median CCI score of 1 (IQR 0–1) in subjects with non-physical triggers of TC (P < 0.001). Seventy-six (14%) subjects died within 30 days of index diagnosis and 185 (34%) subjects experienced severe shock. The median duration of hospitalization was 7 days (IQR 3–14 days). In multivariable logistic regression, CCI was not associated with 30-day mortality or severe shock. In multivariable Poisson regression, CCI (IRR 1.17, 95% CI 1.16–1.18, P < 0.001) was associated with duration of hospitalization. Increased burden of pre-existing medical comorbidity was not independently associated with 30-day mortality or severe shock at index presentation, but was associated with increased duration of hospitalization after diagnosis of TC.
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影响因子：
2.5
作者：
Yamashita, Kotaro;Watanabe, Masayuki;Imamura, Yu
通讯作者：
Imamura, Yu
影响因子：
3.9
作者：
Tseng LJ;Yu HY;Wang CH;Chi NH;Huang SC;Chou HW;Shih HC;Chou NK;Chen YS
通讯作者：
Chen YS
影响因子：
5.1
作者：
Huang, You-qun;Gou, Rong;Liu, Fang
通讯作者：
Liu, Fang
影响因子：
4.8
作者：
Prasad, Abhiram;Lerman, Amir;Rihal, Charanjit S.
通讯作者：
Rihal, Charanjit S.
影响因子：
158.5
作者：
Templin, C.;Ghadri, J. R.;Luescher, T. F.
通讯作者：
Luescher, T. F.