Clinical Cardiac Electrophysiology Service, Department of Medicine, Rush University Medical Center, Chicago, Illinois 60612, USA.
Heart Rhythm. 2011 Apr;8(4):555-61. doi: 10.1016/j.hrthm.2010.12.012. Epub 2010 Dec 10.
Stress cardiomyopathy (SCM) is a syndrome of transient ventricular dysfunction triggered by severe emotional or physical stress, likely resulting from catecholamine-mediated myocardial toxicity. Repolarization abnormalities associated with other hyperadrenergic states can cause QT prolongation and lethal arrhythmia including torsades de pointes (TdP). Despite the development of repolarization abnormalities and QT prolongation in SCM, little is known about the risk of ventricular fibrillation (VF) and TdP.
The aim of this study was to assess the prevalence and clinical predictors of ventricular arrhythmias in a cohort of patients with SCM.
Data from a registry of consecutive patients with SCM from 2 institutions were reviewed. Patients who developed VF or TdP were identified. Clinical characteristics and outcomes were analyzed and compared with a control group of patients with SCM without VF/TdP.
Of 93 patients with SCM, 8 (8.6%) experienced VF/TdP. Of these 8 patients, 2 presented with VF and were subsequently diagnosed with SCM. Six other patients experienced pause-dependent TdP or VF after SCM diagnosis in the setting of substantial QT prolongation. Prolongation of the corrected QT interval (QTc) was significantly associated with the occurrence of ventricular arrhythmia (odds ratio 1.28 for each 10 ms increase in QTc, 95% confidence interval 1.10 to 1.50).
SCM can be associated with life-threatening ventricular arrhythmia in over 8% of cases. SCM should be recognized among the causes of acquired long QT syndrome and can be associated with a risk of TdP.
应激性心肌病（SCM）是一种由严重情绪或身体应激引发的短暂性心室功能障碍综合征，可能是由于儿茶酚胺介导的心肌毒性所致。与其他高肾上腺素状态相关的复极异常可导致 QT 延长和致命性心律失常，包括尖端扭转型室性心动过速（TdP）。尽管 SCM 存在复极异常和 QT 延长，但对室性颤动（VF）和 TdP 的风险知之甚少。
本研究旨在评估 SCM 患者队列中心律失常的发生率和临床预测因素。
回顾了来自 2 个机构的连续 SCM 患者登记处的数据。确定发生 VF 或 TdP 的患者。分析临床特征和结局，并与 SCM 无 VF/TdP 的对照组进行比较。
在 93 例 SCM 患者中，有 8 例（8.6%）发生 VF/TdP。这 8 例患者中，2 例出现 VF，随后被诊断为 SCM。另外 6 例患者在 SCM 诊断后出现与 QT 延长相关的停搏依赖性 TdP 或 VF。校正 QT 间期（QTc）延长与室性心律失常的发生显著相关（QTc 每增加 10 ms，发生室性心律失常的优势比为 1.28，95%置信区间为 1.10 至 1.50）。
SCM 可导致超过 8%的病例发生危及生命的室性心律失常。SCM 应被认为是获得性长 QT 综合征的病因之一，并且可能与 TdP 的风险相关。
