应激性心肌病患者舒张功能的发生率及其对长期预后的临床影响。

Prevalence of diastolic function and clinical impact on long-term outcome in takotsubo cardiomyopathy.

机构信息

Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA; Division of Cardiology, Anzhen Hospital Capital Medical University, Beijing 100053, China.

Division of Cardiovascular Diseases, Mayo Clinic, Rochester, MN, USA.

出版信息

Int J Cardiol. 2017 Oct 1;244:7-12. doi: 10.1016/j.ijcard.2017.06.068.

DOI:10.1016/j.ijcard.2017.06.068

PMID:28784454

Abstract

BACKGROUND

Takotsubo cardiomyopathy (TTC) is a syndrome characterized by transient regional systolic dysfunction of the left ventricle (LV). However, far fewer reports focused on the prevalence of left ventricular diastolic function (DF) and its impact on an adverse prognosis in TTC.

METHODS

From January 2005 to October 2014, 205 consecutive TTC patients (mean age, 70±12years; 95% female) were studied. The patients underwent transthoracic echocardiography at the acute phase and recovery phase (mean, 38±16days after admission).

RESULTS

DF was labeled as normal, mild, moderate and severe. At the acute phase, Abnormal DF was present in 108 patients (53%), and left ventricular ejection fraction (LVEF) <50% in 156 patients (76%). At the recovery phase, DF was unchanged for 104 patients (51%), 44 patients (21%) had worsened, 57 patients (28%) had improved in DF grade. 25 patients (12%) had an LVEF <50%. During 2years of follow-up, 34 patients developed clinical adverse events. Kaplan-Meier analysis estimated that the subgroup with unimproved DF and LVEF <50% at recovery phase had the worst 2-year survival. In multivariable analysis, unimproved DF with LVEF <50% and heart rate (HR) remained predictors of clinical adverse events.

CONCLUSIONS

The current study demonstrated that consideration of both change of DF and LVEF allows identification of subgroups with divergent long-term prognoses in patients with TTC, and may indicate the need for a different management in the high-risk TTC patients.

摘要

背景

Takotsubo 心肌病（TTC）是一种以左心室（LV）短暂区域性收缩功能障碍为特征的综合征。然而，很少有研究关注 TTC 患者左心室舒张功能（DF）的患病率及其对不良预后的影响。

方法

从 2005 年 1 月至 2014 年 10 月，连续纳入 205 例 TTC 患者（平均年龄 70±12 岁；95%为女性）。患者在急性期和恢复期（入院后平均 38±16 天）接受经胸超声心动图检查。

结果

DF 被标记为正常、轻度、中度和重度。在急性期，108 例（53%）患者存在异常 DF，156 例（76%）患者左心室射血分数（LVEF）<50%。在恢复期，104 例（51%）患者的 DF 无变化，44 例（21%）患者恶化，57 例（28%）患者 DF 分级改善。25 例（12%）患者 LVEF<50%。在 2 年随访期间，34 例患者发生临床不良事件。Kaplan-Meier 分析估计，恢复期 DF 无改善且 LVEF<50%的亚组 2 年生存率最差。多变量分析显示，恢复期 DF 无改善且 LVEF<50%和心率（HR）仍然是临床不良事件的预测因素。