Department of Internal Medicine, University of Iowa Hospitals and Clinics, Iowa City, IA, 52242, USA.
Division of Hematology/Oncology, Tulane University, Tulane Avenue, New Orleans, LA, 70125, USA.
J Cancer Res Clin Oncol. 2018 Aug;144(8):1539-1545. doi: 10.1007/s00432-018-2661-1. Epub 2018 May 14.
Chemotherapy-induced cardiomyopathy is a critical complication of treatment for cancer. The emotional stress of a cancer diagnosis, ongoing chemotherapy, abnormal cancer-related wasting syndrome may contribute to cardiac morbidity in these patients. The burden of Takotsubo Cardiomyopathy (TCM) in cancer patients is unknown. The incidence of TCM and related outcomes in cancer patients was investigated in this study.
The 2007-2013 National Inpatient Sample (NIS) was analyzed for patients with a prior and new diagnosis of TCM with and without malignancy. Risk factors for mortality were adjusted for associated conditions by multivariable logistic regression analysis.
From 2007 to 2013, an estimated 122,855 adults were admitted with a diagnosis of TCM. In 2013, the incidence of admissions in US of patients with coexisting TCM and malignancy was 1.13%. Patients admitted for TCM with coexisting malignancy had a significantly higher mortality (13.8 vs. 2.9%, p < 0.0001), length of stay (7 vs. 4 days, p < 0.0001) and total charges ($29,291 vs. $36,231, p < 0.0001), compared to those with no malignancy. In patients with a primary diagnosis of TCM and without any underlying malignancy, males had a higher mortality (4.02 vs. 1.03%, p < 0.0001), whereas there was no gender difference in mortality in those with coexisting malignancy (6.25 vs. 6.45%, p = 0.965). On multivariable logistic regression analysis, risk factors associated with mortality were solid cancer (OR 3.43, p = 0.008), stroke (OR 18.33, p < 0.0001) and heart failure (OR 1.918, p = 0.004).
Outcomes are significantly worse in patients with TCM and malignancy. Hence, this patient population must be regarded as high-risk and early diagnostic consideration for TCM is warranted. Early intervention may help lower mortality, decrease resource utilization and reduce the health care costs in these patients.
化疗诱导性心肌病是癌症治疗的一个严重并发症。癌症诊断带来的情绪压力、持续的化疗、异常的癌症相关消耗综合征可能导致这些患者出现心脏发病率。在癌症患者中，Takotsubo 心肌病（TCM）的负担尚不清楚。本研究调查了癌症患者中 TCM 的发病率及相关结局。
分析了 2007-2013 年国家住院患者样本（NIS）中既往和新发 TCM 伴或不伴恶性肿瘤患者的资料。通过多变量逻辑回归分析，调整相关疾病的死亡率相关风险因素。
2007 年至 2013 年，估计有 122855 名成年人被诊断患有 TCM。2013 年，美国同时患有 TCM 和恶性肿瘤的患者入院率为 1.13%。患有合并恶性肿瘤的 TCM 患者的死亡率显著更高（13.8%比 2.9%，p<0.0001），住院时间（7 天比 4 天，p<0.0001）和总费用（29291 美元比 36231 美元，p<0.0001），与无恶性肿瘤的患者相比。在原发性 TCM 且无任何潜在恶性肿瘤的患者中，男性死亡率更高（4.02%比 1.03%，p<0.0001），而合并恶性肿瘤的患者中性别对死亡率没有影响（6.25%比 6.45%，p=0.965）。多变量逻辑回归分析表明，与死亡率相关的危险因素包括实体瘤（OR 3.43，p=0.008）、中风（OR 18.33，p<0.0001）和心力衰竭（OR 1.918，p=0.004）。
TCM 合并恶性肿瘤患者的结局明显较差。因此，此类患者人群必须被视为高危人群，早期诊断 TCM 是合理的。早期干预可能有助于降低死亡率、减少资源利用并降低此类患者的医疗保健费用。
