Prasitlumkum Narut, Kittipibul Veraprapas, Limpruttidham Nath, Rattanawong Pattara, Chongsathidkiet Pakawat, Boondarikpornpant Thosaporn
University of Hawaii Internal Medicine Residency Program, Honolulu, Hawaii.
Faculty of Medicine, Department of Medicine, Chulalongkorn University, Bangkok, Thailand.
Ann Noninvasive Electrocardiol. 2019 Jan;24(1):e12566. doi: 10.1111/anec.12566. Epub 2018 Jun 25.
Atrial fibrillation (AF) is known as the most common arrhythmia and an independent risk factor for mortality. Recent studies suggest that AF is associated with morbidity and mortality in Takotsubo cardiomyopathy (TTC). However, a systematic review and meta-analysis of the literature have not been done. We assessed the association between AF in patients with TTC and mortality by a systematic review of the literature and a meta-analysis.
We comprehensively searched the databases of MEDLINE and EMBASE from inception to January 2018. Included studies were published prospective or retrospective cohort studies that compared all-cause mortality in TTC with AF versus without AF. Data from each study were combined using the random-effects, generic inverse variance method of DerSimonian and Laird to calculate risk ratios and 95% confidence intervals.
Five studies from August 2008 to October 2017 were included in this meta-analysis involving 2,321 subjects with TTC (243 with AF and 2,078 without AF). The presence of AF was associated with all-cause mortality (pooled odds ratio = 2.19, 95% confidence interval: 1.57-3.06, p < 0.001, I = 0%).
Atrial fibrillation increased all-cause mortality by double among patients with TTC compared to without it. Our study suggests that the presence of AF in TTC is prognostic for all-cause mortality.
心房颤动（AF）是最常见的心律失常，也是死亡率的独立危险因素。最近的研究表明，AF与应激性心肌病（TTC）的发病率和死亡率相关。然而，尚未对文献进行系统综述和荟萃分析。我们通过对文献进行系统综述和荟萃分析，评估了TTC患者中AF与死亡率之间的关联。
我们全面检索了MEDLINE和EMBASE数据库，检索时间从数据库建立至2018年1月。纳入的研究为前瞻性或回顾性队列研究，比较了伴有AF和不伴有AF的TTC患者的全因死亡率。使用DerSimonian和Laird的随机效应、通用逆方差方法合并每项研究的数据，以计算风险比和95%置信区间。
本荟萃分析纳入了2008年8月至2017年10月的五项研究，涉及2321例TTC患者（243例伴有AF，2078例不伴有AF）。AF的存在与全因死亡率相关（合并优势比=2.19，95%置信区间：1.57-3.06，p<0.001，I²=0%）。
与无AF的TTC患者相比，AF使TTC患者的全因死亡率增加了一倍。我们的研究表明，TTC患者中AF的存在对全因死亡率具有预后意义。
