Imran Tasnim F, Rahman Ifad, Dikdan Sean, Shah Rashesh, Niazi Osama T, Thirunahari Nandan, Alhaj Eyad, Klapholz Marc, Gaziano J Michael, Djousse Luc
Brigham and Women's Hospital and VA Boston Healthcare System, Harvard Medical School, Boston, Massachusetts.
Rutgers, New Jersey Medical School, Newark, New Jersey.
Pacing Clin Electrophysiol. 2016 Jun;39(6):607-11. doi: 10.1111/pace.12864. Epub 2016 May 4.
Takotsubo cardiomyopathy (TCM) has been associated with repolarization abnormalities including QT prolongation and acquired long QT syndrome. However, the association between QT prolongation and clinical outcomes in patients with TCM remains unclear. The aim of this study is to examine the association between QT prolongation and ventricular arrhythmias, cardiogenic shock, and death in patients with TCM.
Forty-six patients with TCM met our inclusion criteria in an ongoing prospective cohort database from 2010 to May 2015. We assigned the patients to a long QT group or a normal QT group, and created a composite outcome consisting of ventricular arrhythmias, cardiogenic shock, or death.
The mean age of the participants was 59.7 ± 16 years, 67% were women, and 63% had hypertension. Median follow-up time was 3.1 years (interquartile range: 2.0-3.8), with a total of 133.8 person-years. The mean left ventricular ejection fraction at diagnosis was 27.2% ± 1.4%. The mean QTc on diagnosis was 484 ms ± 10.2 ms for men, and 488 ms ± 8.6 ms for women. The long QT group had a 4.1-times higher odds of having the composite clinical outcome as compared to the normal QT group (95% confidence interval: 1.1, 16.1, P = 0.04) after adjusting for age and race in logistic regression.
Patients with TCM who have a long QT interval or develop acquired long QT syndrome due to TCM may be more likely to be intubated; require vasopressors; and develop shock, ventricular arrhythmias, and death than those with a normal QT interval.
应激性心肌病（TCM）与复极异常有关，包括QT间期延长和获得性长QT综合征。然而，TCM患者QT间期延长与临床结局之间的关联仍不明确。本研究的目的是探讨TCM患者QT间期延长与室性心律失常、心源性休克及死亡之间的关联。
在一个从2010年至2015年5月的前瞻性队列数据库中，46例TCM患者符合我们的纳入标准。我们将患者分为长QT组和正常QT组，并创建了一个由室性心律失常、心源性休克或死亡组成的复合结局。
参与者的平均年龄为59.7±16岁，67%为女性，63%患有高血压。中位随访时间为3.1年（四分位间距：2.0 - 3.8），总计133.8人年。诊断时左心室射血分数的平均值为27.2%±1.4%。男性诊断时的平均QTc为484 ms±10.2 ms，女性为488 ms±8.6 ms。在逻辑回归中对年龄和种族进行校正后，长QT组出现复合临床结局的几率比正常QT组高4.1倍（95%置信区间：1.1, 16.1，P = 0.04）。
与QT间期正常的TCM患者相比，QT间期延长或因TCM而发生获得性长QT综合征的患者可能更有可能需要插管；需要血管升压药；并发生休克、室性心律失常和死亡。
