Cha Yong Sung, Kim Hyun, Bang Min Hyuk, Kim Oh Hyun, Kim Hyung Il, Cha KyoungChul, Lee Kang Hyun, Hwang Sung Oh
Department of Emergency Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea.
Department of Emergency Medicine, Yonsei University, Wonju College of Medicine, Wonju, Republic of Korea.
Am J Emerg Med. 2016 Feb;34(2):140-4. doi: 10.1016/j.ajem.2015.09.038. Epub 2015 Oct 3.
Anaphylaxis is an acute, lethal, multisystem syndrome that results from the sudden release of mast cell- and basophil-derived mediators. Although anaphylaxis can cause cardiac complications, the incidence of myocardial injury using troponin I (TnI) has not been characterized. In addition, patterns of cardiomyopathy have not been evaluated in patients with elevated TnI. Therefore, we studied the occurrence and patterns of myocardial injury with TnI and echocardiography in anaphylaxis.
We conducted a retrospective review of 300 consecutive anaphylaxis cases that were diagnosed in the emergency department (ED) over 53 months (2011-2015). Myocardial injury was defined as elevation of TnI within 24hrs after arrival at the ED. We investigated systolic function and regional wall motion abnormality (RWMA) through echocardiography within 5 hours after arrival at the ED in patients with myocardial injury.
Among 300 patients (median age, 55 years), 22 patients demonstrated myocardial injury (7.3%). The median TnI was 0.222 ng/mL with a range from 0.057 ng/mL to 19.4 ng/mL. Three patients presented reduced systolic function and 4 patients showed RWMA. One patient showed reverse Takotsubo cardiomyopathy and other 2 patients had RWMA discordant to the distribution of coronary arteries. Another patient showed RWMA (inferior wall) with ST elevation of II, III, and aVF. All 4 patients were discharge after recovery of cardiomyopathy without any specific intervention for cardiomyopathy.
Myocardial injury developed in 7.3% of patients with anaphylaxis. Various cardiomyopathy, including Kounis syndrome and Takotsubo cardiomyopathy, has been observed in patients with myocardial injury.
过敏反应是一种急性、致命的多系统综合征，由肥大细胞和嗜碱性粒细胞衍生介质的突然释放引起。尽管过敏反应可导致心脏并发症，但使用肌钙蛋白I（TnI）评估心肌损伤的发生率尚未明确。此外，TnI升高的患者中尚未评估心肌病的类型。因此，我们研究了过敏反应中TnI及超声心动图检查的心肌损伤的发生情况及类型。
我们对53个月（2011 - 2015年）期间在急诊科（ED）诊断的300例连续过敏反应病例进行了回顾性研究。心肌损伤定义为到达ED后24小时内TnI升高。我们对心肌损伤患者在到达ED后5小时内通过超声心动图检查研究收缩功能和节段性室壁运动异常（RWMA）。
在300例患者（中位年龄55岁）中，22例出现心肌损伤（7.3%）。TnI中位数为0.222 ng/mL，范围为0.057 ng/mL至19.4 ng/mL。3例患者出现收缩功能降低，4例出现RWMA。1例患者表现为反向Takotsubo心肌病，另外2例患者的RWMA与冠状动脉分布不一致。另1例患者表现为下壁RWMA伴II、III和aVF导联ST段抬高。所有4例患者在心肌病恢复后出院，未对心肌病进行任何特殊干预。
7.3%的过敏反应患者发生心肌损伤。在心肌损伤患者中观察到了包括Kounis综合征和Takotsubo心肌病在内的各种心肌病。
