Jung Yoon-Seok, Lee Ji-Sook, Min Young-Gi, Park Jin-Sun, Jeon Woo-Chan, Park Eun-Jung, Shin Joon-Han, Oh Sungho, Choi Sang-Cheon
Department of Emergency Medicine, Ajou University School of Medicine.
Circ J. 2014;78(6):1437-44. doi: 10.1253/circj.cj-13-1282. Epub 2014 Apr 4.
Previous reports demonstrated mechanisms of cardiac toxicity in acute carbon monoxide (CO) poisoning. Still, none established CO-induced cardiomyopathy (CMP) as a clinical entity. The aim of this study is to investigate CO-induced CMP in patients with acute CO poisoning in terms of its epidemiology, clinical characteristics, and prognosis.
A retrospective study was conducted on consecutive patients who were diagnosed with acute CO poisoning at the emergency department of Ajou University Hospital during the period of 62 month. Six hundred and twenty-six patients were diagnosed with acute CO poisoning. During the initial echocardiography, 19 patients were abnormal: (1) global hypokinesia/akinesia (n=7), (2) regional wall hypokinesia/akinesia [n=12; takotsubo type (n=6), reverse takotsubo type (n=2), non-specific type (n=4)]. The ejection fraction (EF) was 36.3±13.5% (from 15% to 55%) and less than 45% for 14 patients. In the follow-up echocardiography performed within 12 days after the initial performance, most patients were found to have cardiac wall motion abnormalities, and their EF had returned to normal (ie, EF ≥50%).
CO-induced CMP was identified in 3.04% (n=19) of all patients (n=626). It might not be too critical in acute clinical courses of acute CO poisoning because the prognosis seems favorable. Considering the common factors between CO-induced CMP and takotsubo CMP, myocardial stunning subject to a catecholamine surge most likely plays a central role in the development of CO-induced CMP.
既往报道阐述了急性一氧化碳（CO）中毒时心脏毒性的机制。然而，尚无研究将CO诱导的心肌病（CMP）确立为一种临床实体。本研究旨在从流行病学、临床特征及预后方面，对急性CO中毒患者中CO诱导的CMP展开调查。
对阿朱大学医院急诊科在62个月期间连续诊断为急性CO中毒的患者进行了一项回顾性研究。626例患者被诊断为急性CO中毒。在初次超声心动图检查时，19例患者存在异常：（1）整体运动减弱/运动不能（n = 7），（2）局部室壁运动减弱/运动不能[n = 12；应激性心肌病型（n = 6），反转型应激性心肌病型（n = 2），非特异性型（n = 4）]。射血分数（EF）为36.3±13.5%（范围为15%至55%），14例患者的EF低于45%。在初次检查后12天内进行的随访超声心动图检查中，多数患者被发现存在室壁运动异常，且其EF已恢复正常（即EF≥50%）。
在所有患者（n = 626）中，3.04%（n = 19）被确定为CO诱导的CMP。在急性CO中毒的急性临床病程中，其可能并非十分严重，因为预后似乎良好。鉴于CO诱导的CMP与应激性心肌病之间的共同因素，儿茶酚胺激增导致的心肌顿抑很可能在CO诱导的CMP发生发展中起核心作用。
