Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy
Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy
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DOI：
10.1056/nejmoa1406761
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发表时间：
2015-09-03
影响因子：
158.5
通讯作者：
Luescher, T. F.
中科院分区：
文献类型：
--
作者：
Templin, C.;Ghadri, J. R.;Luescher, T. F.
背景：应激性心肌病的自然病史、治疗和结局尚不完全清楚。方法国际Takotsubo注册中心是一个由欧洲和美国26个中心组成的联盟，旨在研究Takotsubo心肌病的临床特征、预后预测因素和结局。将患者与年龄和性别匹配的急性冠状动脉综合征患者进行比较。结果1750例takotsubo型心肌病患者中，89.8%为女性（平均年龄66.8岁）。情绪诱因不如身体诱因常见（27.7% vs. 36.0%）， 28.5%的患者无明显诱因。在takotsubo心肌病患者中，与急性冠状动脉综合征相比，神经或精神疾病的发生率更高（55.8% vs. 25.7%），平均左室射血分数显著降低（40.7 +/- 11.2% vs. 51.5 +/- 12.3%）（两种比较的P < 0.001）。两组患者院内严重并发症发生率（包括休克和死亡）相似（P = 0.93）。生理诱因、急性神经或精神疾病、高肌钙蛋白水平和入院时低射血分数是院内并发症的独立预测因素。在长期随访中，主要心脑血管不良事件发生率为9.9% /患者年，死亡率为5.6% /患者年。结论takotsubo型心肌病患者比急性冠状动脉综合征患者有更高的神经或精神疾病患病率。这种情况是一种急性心力衰竭综合征，发病率和死亡率都很高。（由machi - gaensslen基金会等资助；ClinicalTrials.gov编号：NCT01947621。）
BACKGROUNDThe natural history, management, and outcome of takotsubo (stress) cardiomyopathy are incompletely understood.METHODSThe International Takotsubo Registry, a consortium of 26 centers in Europe and the United States, was established to investigate clinical features, prognostic predictors, and outcome of takotsubo cardiomyopathy. Patients were compared with age- and sex-matched patients who had an acute coronary syndrome.RESULTSOf 1750 patients with takotsubo cardiomyopathy, 89.8% were women (mean age, 66.8 years). Emotional triggers were not as common as physical triggers (27.7% vs. 36.0%), and 28.5% of patients had no evident trigger. Among patients with takotsubo cardiomyopathy, as compared with an acute coronary syndrome, rates of neurologic or psychiatric disorders were higher (55.8% vs. 25.7%) and the mean left ventricular ejection fraction was markedly lower (40.7 +/- 11.2% vs. 51.5 +/- 12.3%) (P < 0.001 for both comparisons). Rates of severe in-hospital complications including shock and death were similar in the two groups (P = 0.93). Physical triggers, acute neurologic or psychiatric diseases, high troponin levels, and a low ejection fraction on admission were independent predictors for in-hospital complications. During long-term follow-up, the rate of major adverse cardiac and cerebrovascular events was 9.9% per patient-year, and the rate of death was 5.6% per patient-year.CONCLUSIONSPatients with takotsubo cardiomyopathy had a higher prevalence of neurologic or psychiatric disorders than did those with an acute coronary syndrome. This condition represents an acute heart failure syndrome with substantial morbidity and mortality. (Funded by the Mach-Gaensslen Foundation and others; ClinicalTrials.gov number, NCT01947621.)