University of Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Centre Hospitalier Universitaire, Nouvel Hôpital Civil, Strasbourg, France.
Department of Cardiology, Austin and Northern Health, Melbourne, Australia.
Europace. 2019 Feb 1;21(2):298-305. doi: 10.1093/europace/euy147.
Takotsubo cardiomyopathy (TTC) is a stress-related transient cardiomyopathy. It is unclear whether TTC is associated with poorer prognosis when atrial arrhythmia (AA), atrial fibrillation or flutter, occurs. The purpose of this study was to assess the incidence of AA in patients with TTC, predictive factors of AA, and its association with mortality.
We studied 214 consecutive cases of TTC over 8 years. The study cohort was divided into two groups-those with newly diagnosed AA (AA-group) and those without (non-AA group). AA occurred in 24.8% of the patients. The AA group presented with lower left ventricular ejection fraction (LVEF) on admission and higher cardiac arrest rate. Admission and peak levels of troponin, B-type natriuretic peptide (BNP), C-reactive protein (CRP), and leucocytes were higher in the AA group. In-hospital, 30-day, cardiovascular, and all-cause mortality were significantly higher in the AA group. Independent predictors of newly diagnosed AA were troponin peak [odds ratio (OR) 1.03 (1.003-1.06); P = 0.029], CRP peak [OR 1.006 (1.001-1.01); P = 0.026], and LVEF on admission [OR 0.96 (0.93-0.99); P = 0.01]. Newly diagnosed AA was not predictive of mortality. The BNP peak [OR 1.00 (1.000-1.001); P = 0.022] and leucocytes peak [OR 1.095 (1.034-1.16); P = 0.002] were predictive factors of in-hospital mortality. LVEF upon discharge [OR 0.935 (0.899-0.972); P = 0.001] and leucocytes peak [OR 1.068 (1.000-1.139); P = 0.049] were predictive of cardiovascular death.
Newly diagnosed AA is frequently observed in patients presenting with TTC and is associated with poorer short- and long-term prognosis. Inflammation, myocardial damage, and LVEF are predictors of AA onset and cardiovascular mortality.
Takotsubo 心肌病（TTC）是一种应激相关的短暂性心肌病。当发生房性心律失常（AA）、心房颤动或扑动时，TTC 是否与预后较差有关尚不清楚。本研究的目的是评估 TTC 患者 AA 的发生率、AA 的预测因素及其与死亡率的关系。
我们研究了 8 年来连续 214 例 TTC 患者。研究队列分为两组——新诊断为 AA（AA 组）和无 AA（非 AA 组）。24.8%的患者出现 AA。AA 组入院时左心室射血分数（LVEF）较低，心搏骤停发生率较高。AA 组入院时和峰值的肌钙蛋白、B 型利钠肽（BNP）、C 反应蛋白（CRP）和白细胞较高。AA 组住院期间、30 天、心血管和全因死亡率显著升高。新诊断为 AA 的独立预测因素是肌钙蛋白峰值[优势比（OR）1.03（1.003-1.06）；P=0.029]、CRP 峰值[OR 1.006（1.001-1.01）；P=0.026]和入院时的 LVEF[OR 0.96（0.93-0.99）；P=0.01]。新诊断的 AA 不是死亡率的预测因素。BNP 峰值[OR 1.00（1.000-1.001）；P=0.022]和白细胞峰值[OR 1.095（1.034-1.16）；P=0.002]是住院期间死亡率的预测因素。出院时的 LVEF[OR 0.935（0.899-0.972）；P=0.001]和白细胞峰值[OR 1.068（1.000-1.139）；P=0.049]是心血管死亡的预测因素。
在出现 TTC 的患者中经常观察到新诊断的 AA，并且与短期和长期预后较差相关。炎症、心肌损伤和 LVEF 是 AA 发作和心血管死亡率的预测因素。
