Department of Cardiovascular Medicine, Vilnius University, Lithuania; Centre of Cardiology and Angiology, Vilnius University Hospitals Santariskiu Klinikos, Lithuania.
Faculty of Medicine, Vilnius University, Lithuania.
Hellenic J Cardiol. 2016 Nov-Dec;57(6):428-434. doi: 10.1016/j.hjc.2016.11.016. Epub 2016 Nov 16.
The natural history, management, and outcome of Takotsubo (stress) cardiomyopathy (TTC) is not clear. The aim of this study was to investigate clinical features, define prognostic predictors, and assess the clinical course and outcomes of patients with TTC.
We analyzed 64 patients (52 women) meeting the proposed Mayo Clinic diagnostic criteria for TTC. All patients were treated at Vilnius University Hospital Santariskiu Klinikos from 2001-01-01 to 2014-11-27. Data were collected on the basis of medical records and follow-up data was collected by phone.
The mean age of analyzed patients was 63.4 ± 14.6 years; the mean follow-up was 2.9 years. More than half of the patients (52%) did not have any clear stressful triggers. During admission, symptoms such as chest pain (64%) and general weakness (45%) were reported more often than other symptoms. Almost all patients (94%) had the classical TTC form; the remaining 6% of patients had "inverted" TTC. The mean left ventricular ejection fraction (LVEF) on admission was 37.7% (± 8.2%). A pseudonormal or restrictive pattern of LV filling, moderate to severe mitral regurgitation (MR), and right ventricular involvement were uncommon in the patients. The in-hospital course showed cardiogenic shock in 23% of the cases, resulting in the death of 5 (8%) patients. We discovered that only peak concentration of troponin I was a significant predictor of in-hospital mortality (HR 1.067, 95%CI 1.022-1.113, p=0.003). At the end of the follow-up period, 45 (87%) women and 8 (67%) men were alive. This makes the overall observed mortality at 3 years approximately 17.2%. Using multivariate analysis, elevation of BNP (HR for increase by 10 ng/l 1.002, 95%CI 1-1.003, p=0.022) and cardiogenic shock on admission (HR 8.696, 95%CI 1.198-63.124, p=0.032) were significant predictors of overall mortality. Other prognostic factors assessed on admission were nonsignificant predictors of overall mortality.
Our analysis shows that in-hospital mortality is influenced by the peak concentration of troponin I, and overall mortality is affected by cardiogenic shock and the elevation of BNP during admission. The assessment of troponin I and BNP can help with the prognostication of TTC patients in our daily clinical practice.
Takotsubo（应激性）心肌病（TTC）的自然病史、治疗方法和转归尚不清楚。本研究旨在探讨其临床特征，确定预后预测因子，并评估 TTC 患者的临床病程和结局。
我们分析了 2001 年 1 月 1 日至 2014 年 11 月 27 日期间在维尔纽斯大学桑塔里基乌斯医院就诊并符合梅奥诊所 TTC 诊断标准的 64 例患者（52 例女性）。所有患者均接受治疗。我们基于病历收集数据，并通过电话进行随访。
分析患者的平均年龄为 63.4±14.6 岁，平均随访时间为 2.9 年。超过一半的患者（52%）没有明确的应激触发因素。住院期间，胸痛（64%）和全身无力（45%）等症状比其他症状更常见。几乎所有患者（94%）均有典型的 TTC 表现，其余 6%的患者有“反转”TTC。入院时左心室射血分数（LVEF）平均为 37.7%（±8.2%）。LV 充盈呈假正常或限制性模式、中重度二尖瓣反流（MR）和右心室受累在患者中并不常见。住院期间有 23%的患者出现心源性休克，导致 5 例（8%）患者死亡。我们发现，只有肌钙蛋白 I 的峰值浓度是院内死亡率的显著预测因子（HR 1.067，95%CI 1.022-1.113，p=0.003）。在随访期末，45 名（87%）女性和 8 名（67%）男性存活。这使得 3 年的总观察死亡率约为 17.2%。使用多变量分析，BNP 升高（每增加 10ng/l 的 HR 为 1.002，95%CI 1-1.003，p=0.022）和入院时的心源性休克（HR 8.696，95%CI 1.198-63.124，p=0.032）是总死亡率的显著预测因子。入院时评估的其他预后因素不是总死亡率的显著预测因子。
我们的分析表明，肌钙蛋白 I 的峰值浓度影响院内死亡率，而 BNP 的升高和入院时的心源性休克影响总死亡率。肌钙蛋白 I 和 BNP 的评估可帮助我们在日常临床实践中对 TTC 患者进行预后评估。
