Kato Ken, Sakai Yoshiaki, Ishibashi Iwao, Himi Toshiharu, Fujimoto Yoshihide, Kobayashi Yoshio
University Heart Center, Department of Cardiology, University Hospital Zurich, Raemistrasse 100, 8091, Zurich, Switzerland.
Department of Cardiovascular Medicine, Chiba University Graduate School of Medicine, Chiba, Japan.
Heart Vessels. 2018 Oct;33(10):1214-1219. doi: 10.1007/s00380-018-1172-y. Epub 2018 Apr 25.
Takotsubo syndrome (TTS) has been recognized as a benign condition mainly due to its reversibility. However, recent researches have demonstrated that serious cardiac complications could occur during hospitalization. Thus, the aim of this study is to detect factors associated with in-hospital cardiac complications in patients with TTS. A total of 154 consecutive patients with TTS were enrolled retrospectively. In-hospital cardiac complications were observed in 61 patients (40%), including 44 patients with pulmonary edema (29%) and 25 patients with cardiogenic shock (16%). Multivariate logistic regression analysis identified lower systolic blood pressure on admission (OR 0.97, 95% CI 0.96-0.99, p = 0.001), history of diabetes mellitus (OR 2.92, 95% CI 1.01-8.41, p = 0.04), and β-blocker use before admission (OR 16.9, 95% CI 1.57-181.7, p = 0.006) as independent predictors of in-hospital cardiac complications, while chest pain at onset was identified as a negative predictor of cardiac complications during hospitalization (OR 0.20, 95% CI 0.07-0.55, p = 0.001). Patients with cardiac complications more often needed hemodynamic support and longer hospital stay than those without (21.2 ± 19.4 vs. 11.8 ± 16.8 days, p = 0.002). TTS should be no longer recognized as a benign disease, but requiring careful management. We should obtain vital signs and patient's medical history carefully as soon as possible after admission to predict in-hospital cardiac complications.
应激性心肌病（TTS）主要因其可逆性而被认为是一种良性疾病。然而，最近的研究表明，住院期间可能会出现严重的心脏并发症。因此，本研究的目的是检测与TTS患者住院期间心脏并发症相关的因素。本研究回顾性纳入了154例连续的TTS患者。61例患者（40%）出现了住院期间心脏并发症，其中44例患者发生肺水肿（29%），25例患者发生心源性休克（16%）。多因素逻辑回归分析确定入院时收缩压较低（比值比[OR]0.97，95%置信区间[CI]0.96 - 0.99，p = 0.001）、糖尿病病史（OR 2.92，95% CI 1.01 - 8.41，p = 0.04）以及入院前使用β受体阻滞剂（OR 16.9，95% CI 1.57 - 181.7，p = 0.006）是住院期间心脏并发症的独立预测因素，而发病时胸痛被确定为住院期间心脏并发症的负性预测因素（OR 0.20，95% CI 0.07 - 0.55，p = 0.001）。与无心脏并发症的患者相比，有心脏并发症的患者更常需要血流动力学支持且住院时间更长（分别为21.2 ± 19.4天和11.8 ± 16.8天，p = 0.002）。TTS不应再被视为一种良性疾病，而需要谨慎管理。入院后应尽快仔细获取生命体征和患者病史，以预测住院期间的心脏并发症。
