在一家三级转诊医院，通过超声心动图诊断应激性心肌病患者的结局。

Outcomes of patients with stress-induced cardiomyopathy diagnosed by echocardiography in a tertiary referral hospital.

机构信息

Division of Cardiology, Asan Medical Center, University of Ulsan College of Medicine, Seoul, South Korea.

出版信息

J Am Soc Echocardiogr. 2010 Jul;23(7):766-71. doi: 10.1016/j.echo.2010.05.002.

DOI:10.1016/j.echo.2010.05.002

PMID:20620862

Abstract

BACKGROUND

Because stress-induced cardiomyopathy (SIC) is increasingly being observed during routine daily practice, we sought to explore the clinical features and factors that determine the outcome of SIC in a tertiary referral hospital.

METHODS

Patients with typical left ventricular (LV) takotsubo (apical ballooning) or inverted takotsubo on 2-dimensional echocardiography were prospectively enrolled, and their clinical data were analyzed.

RESULTS

Over a 63-month period, 56 consecutive patients (median age and interquartile range=64 years [52-74 years]) were identified. Women comprised 79% (44/56) of all patients. The triggering events were acute medical illness, including sepsis and hypoxemia in 29 patients (52%, group A), in-hospital surgery/procedure in 17 patients (30%, group B), and emotional stress in 10 patients (18%, group C). Chest pain was more frequently observed in group C (50%) than in groups A (14%) and B (6%) (P=.021), whereas dyspnea was the presenting symptom in groups A and B. Typical takotsubo and inverted takotsubo were observed in 48 and 8 patients, with a median ejection fraction of 33%. Other abnormalities included dynamic LV outflow tract obstruction (n=2), LV thrombus (n=2), and right ventricular dysfunction (n=12). Nine deaths (16%) occurred during hospitalization. The groups did not differ in mortality. The Acute Physiology and Chronic Health Evaluation II score (odds ratio 1.405; 95% confidence interval, 1.091-1.810; P=.009) and absence of LV function recovery within 1 week (ejection fraction<50%) (odds ratio 14.080; 95% confidence interval, 1.184-167.475; P=.036) were independent factors associated with mortality. During clinical follow-up up to 6 months, 3 more patients died, 2 of whom had recurrences of SIC.

CONCLUSIONS

SIC in a tertiary referral hospital was mainly associated with physical stressors and characterized by diverse clinical presentations, high mortality, and occasional fatal recurrences.

摘要

背景

由于应激性心肌病（SIC）在日常诊疗中越来越常见，我们旨在探讨一家三级转诊医院中 SIC 的临床特征和决定其预后的因素。

方法

前瞻性纳入二维超声心动图示典型左心室（LV）心尖球囊样变或心尖反向运动的患者，并分析其临床资料。

结果

在 63 个月期间，共确诊 56 例连续患者（中位数年龄及四分位间距=64 岁[52-74 岁]）。女性占所有患者的 79%（44/56）。触发事件为急性内科疾病，包括 29 例（52%，A 组）患者的败血症和低氧血症、17 例（30%，B 组）患者的院内手术/操作和 10 例（18%，C 组）患者的情绪压力。C 组（50%）胸痛更常见，而 A 组（14%）和 B 组（6%）胸痛更少见（P=.021），而 A 组和 B 组的首发症状为呼吸困难。48 例患者表现为典型心尖球囊样变，8 例患者表现为心尖反向运动，射血分数中位数为 33%。其他异常包括动态左心室流出道梗阻（n=2）、左心室血栓形成（n=2）和右心室功能障碍（n=12）。9 例患者（16%）住院期间死亡。各组死亡率无差异。急性生理学和慢性健康评估 II 评分（比值比 1.405；95%置信区间，1.091-1.810；P=.009）和 1 周内左心室功能未恢复（射血分数<50%）（比值比 14.080；95%置信区间，1.184-167.475；P=.036）是与死亡率相关的独立因素。在临床随访至 6 个月期间，又有 3 例患者死亡，其中 2 例为 SIC 复发。