Stiermaier Thomas, Möller Christian, Graf Tobias, Eitel Charlotte, Desch Steffen, Thiele Holger, Eitel Ingo
University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, Lübeck, Germany; German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany.
Am J Cardiol. 2016 Dec 1;118(11):1737-1741. doi: 10.1016/j.amjcard.2016.08.055. Epub 2016 Aug 30.
The aim of the present analysis was to evaluate the prognostic impact of different ballooning patterns in patients with Takotsubo cardiomyopathy (TTC). A total of 285 consecutive patients with TTC were included. Clinical characteristics and short- and long-term outcomes were compared between patients with typical apical ballooning (n = 204) and patients with an atypical ballooning pattern including midventricular and basal ballooning (n = 81). Patients with typical apical ballooning were significantly older (73.3 ± 10.2 vs 68.4 ± 10.3 years; p <0.01) and had a higher prevalence of diabetes mellitus (25.5% vs 12.3%; p = 0.02). The initial left ventricular (LV) ejection fraction was significantly lower in case of apical ballooning (41.5 ± 10.4% vs 46.9 ± 10.9%; p <0.01) but recovered to normal values in both groups (58.4 ± 8.0 vs 59.7 ± 7.0; p = 0.25). Although 28-day mortality did not differ significantly (p = 0.10), typical apical ballooning was associated with an increased 6-month (13.4% vs 1.3%; hazard ratio [HR] 10.81, 95% confidence interval [CI] 1.47 to 79.66; p = 0.02) and long-term mortality rates (28.9% vs 14.5%; HR 2.24, 95% CI 1.17 to 4.71; p = 0.02). A landmark analysis which included only patients who survived the first 6 months after the initial event demonstrated similar mortality rates in patients with typical (17.9%) and atypical (13.3%) ballooning (HR 1.36, 95% CI 0.67 to 2.79; p = 0.40). In conclusion, in patients with TTC, typical apical ballooning is associated with more severe LV dysfunction at acute presentation and higher mortality rates within the first 6 months after the initial event. After complete recovery of LV function, prognosis is similar in patients with typical and atypical ballooning patterns.
本分析的目的是评估不同的球囊样扩张模式对Takotsubo心肌病（TTC）患者预后的影响。共纳入了285例连续性TTC患者。比较了典型心尖部球囊样扩张患者（n = 204）和包括心室中部及基底部球囊样扩张的非典型球囊样扩张模式患者（n = 81）的临床特征以及短期和长期预后。典型心尖部球囊样扩张患者年龄显著更大（73.3±10.2岁对68.4±10.3岁；p<0.01），糖尿病患病率更高（25.5%对12.3%；p = 0.02）。心尖部球囊样扩张时初始左心室（LV）射血分数显著更低（41.5±10.4%对46.9±10.9%；p<0.01），但两组均恢复至正常水平（58.4±8.0对59.7±7.0；p = 0.25）。尽管28天死亡率无显著差异（p = 0.10），但典型心尖部球囊样扩张与6个月时更高的死亡率相关（13.4%对1.3%；风险比[HR] 10.81，95%置信区间[CI] 1.47至79.66；p = 0.02）以及长期死亡率（28.9%对14.5%；HR 2.24，95% CI 1.17至4.71；p = 0.02）。一项仅纳入初始事件后存活前6个月患者的标志性分析显示，典型（17.9%）和非典型（13.3%）球囊样扩张患者的死亡率相似（HR 1.36，95% CI 0.67至2.79；p = 0.40）。总之，在TTC患者中，典型心尖部球囊样扩张在急性发作时与更严重的LV功能障碍相关，且在初始事件后的前6个月内死亡率更高。LV功能完全恢复后，典型和非典型球囊样扩张模式患者的预后相似。
