Kato Ken, Kitahara Hideki, Saito Yuichi, Fujimoto Yoshihide, Sakai Yoshiaki, Ishibashi Iwao, Himi Toshiharu, Kobayashi Yoshio
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
J Cardiol. 2017 Dec;70(6):615-619. doi: 10.1016/j.jjcc.2017.04.004. Epub 2017 May 15.
Prevalence of myocardial bridging of the left anterior descending coronary artery (LAD) in patients with takotsubo syndrome (TTS) has been demonstrated. However, the impact of myocardial bridging on in-hospital outcome has not been fully evaluated.
A total of 144 consecutive patients with TTS were enrolled. Coronary angiography and left ventriculography were performed in all patients and absence of obstructive coronary disease explaining the left ventricular contraction abnormality was confirmed. Myocardial bridging was diagnosed when a dynamic compression in systole, so-called "milking effect", was observed in the LAD. We evaluated differences in the clinical characteristics and in-hospital outcome between patients with and without myocardial bridging. Furthermore, multiple logistic regression analysis was performed to predict in-hospital death.
Myocardial bridging was observed in 33 patients (23%). In-hospital death was more frequent in patients with myocardial bridging (21% vs. 6%, p=0.02), which was due mainly to a higher non-cardiac death in those patients (15% vs. 5%, p=0.049). Multiple logistic regression analysis demonstrated myocardial bridging (odds ratio=12.0, 95% CI=2.52-78.5, p<0.01) as one of the independent predictors of in-hospital death.
Myocardial bridging is an independent predictor of in-hospital death in patients with TTS.
已证实应激性心肌病（TTS）患者左前降支冠状动脉（LAD）心肌桥的患病率。然而，心肌桥对住院结局的影响尚未得到充分评估。
连续纳入144例TTS患者。所有患者均进行了冠状动脉造影和左心室造影，并确认不存在可解释左心室收缩异常的阻塞性冠状动脉疾病。当在LAD中观察到收缩期动态压迫，即所谓的“挤奶效应”时，诊断为心肌桥。我们评估了有无心肌桥患者的临床特征和住院结局差异。此外，进行了多因素逻辑回归分析以预测住院死亡。
33例患者（23%）观察到心肌桥。心肌桥患者的住院死亡更为常见（21%对6%，p = 0.02），这主要是由于这些患者中非心源性死亡较高（15%对5%，p = 0.049）。多因素逻辑回归分析表明，心肌桥（比值比 = 12.0，95%可信区间 = 2.52 - 78.5，p < 0.01）是住院死亡的独立预测因素之一。
心肌桥是TTS患者住院死亡的独立预测因素。
