El-Battrawy Ibrahim, Ansari Uzair, Lang Siegfried, Behnes Michael, Schramm Katja, Fastner Christian, Zhou Xiaobo, Kuschyk Jürgen, Tülümen Erol, Röger Susanne, Borggrefe Martin, Akin Ibrahim
First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.
DZHK (GermanCenter for Cardiovascular Research), Mannheim, Germany.
Eur J Clin Invest. 2017 Jul;47(7):477-485. doi: 10.1111/eci.12768. Epub 2017 Jun 20.
Early research has proposed that patients with Takotsubo syndrome (TTS) could have a higher mortality rate than the general population. Our study was conducted to determine the short- and long-term outcome of TTS patients associated with a significantly compromised left ventricular function on hospital admission.
Our institutional database constituted a collective of 112 patients diagnosed with TTS between 2003 and 2015. The patients were classified into two groups based on the left ventricular ejection fraction (LVEF), with those presenting with a LVEF > 35% on admission categorized into one group (n = 65, 58%) and those presenting with LVEF ≤ 35% (n=47, 42%) categorized into another group. The endpoint was the all-cause of mortality over a mean follow-up of 1529 ± 1121 days.
Preliminary results indicated that patients with an EF ≤ 35% had a significantly greater risk of developing life-threatening arrhythmias, and were much more likely to suffer from cardiogenic shock. Patients often required varying forms of mechanical respiratory support. The in-hospital mortality, 30-day mortality, 1-year mortality and ongoing long-term mortality was significantly higher in TTS patients with an EF ≤ 35%. In a multivariate Cox regression analysis, an EF ≤ 35% (HR 3·3, 95% CI: 1·2-9·2, P < 0·05) was identified as a strong independent predictor of the primary endpoint.
In-hospital events as well as short- and long-term mortality rates among TTS patients diagnosed with a significantly reduced LVEF on admission were significantly higher. There is an urgent need for randomized trials, which could help define uniform clinical management strategies for high risk TTS patients.
早期研究表明，应激性心肌病（TTS）患者的死亡率可能高于普通人群。我们开展这项研究以确定入院时左心室功能严重受损的TTS患者的短期和长期预后。
我们机构的数据库收集了2003年至2015年间诊断为TTS的112例患者。根据左心室射血分数（LVEF）将患者分为两组，入院时LVEF>35%的患者分为一组（n = 65，58%），LVEF≤35%的患者分为另一组（n = 47，42%）。终点指标是在平均1529±1121天的随访期内的全因死亡率。
初步结果表明，EF≤35%的患者发生危及生命心律失常的风险显著更高，且更易发生心源性休克。患者常需要不同形式的机械通气支持。EF≤35%的TTS患者的院内死亡率、30天死亡率、1年死亡率及持续的长期死亡率显著更高。在多因素Cox回归分析中，EF≤35%（HR 3·3，95%CI：1·2 - 9·2，P < 0·05）被确定为主要终点的强独立预测因素。
入院时诊断为LVEF显著降低的TTS患者的院内事件以及短期和长期死亡率均显著更高。迫切需要进行随机试验，以帮助确定高危TTS患者统一的临床管理策略。
