Takotsubo（应激性）心肌病的临床特征和转归。
Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy.
机构信息
From University Heart Center, Department of Cardiology (C. Templin, J.R.G., J.D., D.R.B., M.J., V.L.C., V.G., C.A.N., M.S., P.E., F.R., T.F.L.), and Department of Psychiatry and Psychotherapy (K. Eisenhardt, J.J.), University Hospital Zurich, and Division of Biostatistics, Epidemiology, Biostatistics, and Prevention Institute, University of Zurich (B.S.), Zurich, Spitalregion Rheintal Werdenberg Sarganserland, Altstätten (J.H.), Department of Cardiology, Kantonsspital Lucerne, Lucerne (F. Cuculi, P.E.), Department of Cardiology, Kantonsspital Winterthur, Winterthur (T.A.F.), and Department of Cardiology, University Hospital Basel, Basel (C.K., S.O.) - all in Switzerland; Department of Cardiology and Angiology, Hannover Medical School, Hannover (L.C.N., J.B.), Department of Cardiology, Heidelberg University Hospital, Heidelberg (J.F., H.A.K.), Deutsches Herzzentrum München, Technische Universität München (C.B., H.S., W.K.), and DZHK (German Center for Cardiovascular Research), partner site Munich Heart Alliance (H.S., W.K.), Munich, University Heart Center Lübeck, Medical Clinic II, Department of Cardiology, Angiology and Intensive Care Medicine, Lübeck (C.M., H.T.), DZHK, partner site Hamburg/Kiel/Lübeck (C.M., H.T., M.K.), Division of Cardiology, Asklepios Clinics St. Georg Hospital (A.C., K.-H.K.), and Department of General and Interventional Cardiology, University Heart Center Hamburg (M.K.), Hamburg, Department of Cardiology, Charité, Campus Rudolf Virchow, Berlin (C. Tschöpe, H.-P.S.), Department of Internal Medicine III, Heart Center University of Cologne, Cologne (G.M., R.P.), Department of Internal Medicine III, Cardiology, Angiology, and Intensive Care Medicine, Saarland University, Homburg (C.U., M.B.), Department of Cardiology, University Hospital Essen, Essen (R.E.), Clinic for Cardiology and Pneumology, Georg August University Göttingen (C.J., G.H.), and DZHK, partner site Göttingen (C.J., G.H.), Göttingen, Department of Internal Medicine II
出版信息
N Engl J Med. 2015 Sep 3;373(10):929-38. doi: 10.1056/NEJMoa1406761.
BACKGROUND
The natural history, management, and outcome of takotsubo (stress) cardiomyopathy are incompletely understood.
METHODS
The 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.
RESULTS
Of 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.
CONCLUSIONS
Patients 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.).
背景
心肌顿抑（应激性）的自然病史、处理和结局尚不完全清楚。
方法
国际心肌顿抑注册研究是由欧洲和美国的 26 个中心组成的联盟，旨在研究心肌顿抑的临床特征、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
在 1750 例心肌顿抑患者中，89.8%为女性（平均年龄 66.8 岁）。情绪诱因不如躯体诱因常见（27.7%比 36.0%），28.5%的患者无明显诱因。与急性冠状动脉综合征相比，心肌顿抑患者中神经系统或精神疾病的发生率较高（55.8%比 25.7%），左心室射血分数明显较低（40.7±11.2%比 51.5±12.3%）（均 P<0.001）。两组严重院内并发症（包括休克和死亡）发生率相似（P=0.93）。物理诱因、急性神经系统或精神疾病、高肌钙蛋白水平和入院时射血分数较低是院内并发症的独立预测因素。在长期随访中，每例患者每年主要不良心脏和脑血管事件发生率为 9.9%，每例患者每年死亡率为 5.6%。
结论
与急性冠状动脉综合征患者相比，心肌顿抑患者的神经系统或精神疾病发生率更高。这种情况代表一种急性心力衰竭综合征，具有较高的发病率和死亡率。（由 Mach-Gaensslen 基金会等资助；ClinicalTrials.gov 编号，NCT01947621。）
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