Mathew Anoop, Shanks Miriam, Punnoose Eapen, Fischer Louie, Koshy George, Potluri Rahul, Bainey Kevin R
Division of Cardiology, Malankara Orthodox Syrian Church (MOSC) Medical College Hospital, India.
Division of Cardiology, University of Alberta, Canada.
Eur Heart J Acute Cardiovasc Care. 2020 Dec;9(8):975-983. doi: 10.1177/2048872618809319. Epub 2018 Nov 8.
Myocardial inflammation often complicates leptospirosis, a re-emerging global zoonosis. Leptospirosis associated myocardial dysfunction is equivocal and the pattern of cardiac involvement may not differ from that of sepsis associated myocarditis.
We prospectively compared cardiac involvement in 113 intensive care unit patients with severe leptospirosis to 31 patients with sepsis syndrome using a comprehensive assessment comprising of clinical presentation, electrocardiography, two-dimensional echocardiography (with global longitudinal strain calculation), and cardiac biomarker evaluation. Binomial logistic regression was performed to identify independent predictors of left ventricular systolic dysfunction in leptospirosis.
Compared to sepsis syndrome, leptospirosis patients were younger, had higher body mass index measurements and were more likely to be smokers. Electrocardiography abnormalities were common and similar in both groups. Myocardial systolic dysfunction was common in both groups (leptospirosis: 55.86% vs sepsis syndrome: 51.61%, =0.675) with subclinical left ventricular systolic dysfunction (characterized by abnormal global longitudinal strain and normal left ventricular ejection fraction) being most frequent followed by isolated right ventricular systolic dysfunction, isolated left ventricular systolic dysfunction, and bi-ventricular systolic dysfunction (leptospirosis: 31.43%, 18.42%, 13.16%, 10.53%, respectively; sepsis syndrome: 22.22%, 12.00%, 12.00%, 8.00%, respectively (>0.05 for each comparator)). Leptospirosis patients had a trend towards greater troponin-T elevation (61.0% vs 40.0%, =0.057). ST-segment elevation and elevated troponin were independent predictors of reduced left ventricular ejection fraction in leptospirosis.
Cardiac involvement in leptospirosis appears to be similar to that of sepsis syndrome, with myocardial systolic dysfunction being common. As such, clinical vigilance pertaining to cardiac status is paramount in these high-risk patients.
心肌炎症常使钩端螺旋体病复杂化，这是一种再度在全球出现的人畜共患病。钩端螺旋体病相关的心肌功能障碍尚不明确，且心脏受累模式可能与脓毒症相关心肌炎并无差异。
我们前瞻性地比较了113例患有严重钩端螺旋体病的重症监护病房患者与31例脓毒症综合征患者的心脏受累情况，采用了包括临床表现、心电图、二维超声心动图（计算整体纵向应变）和心脏生物标志物评估在内的综合评估方法。进行二项逻辑回归以确定钩端螺旋体病中左心室收缩功能障碍的独立预测因素。
与脓毒症综合征相比，钩端螺旋体病患者更年轻，体重指数测量值更高，且更有可能是吸烟者。两组心电图异常均很常见且相似。两组心肌收缩功能障碍均很常见（钩端螺旋体病：55.86% 对脓毒症综合征：51.61%，P = 0.675），亚临床左心室收缩功能障碍（以整体纵向应变异常和左心室射血分数正常为特征）最为常见，其次是孤立性右心室收缩功能障碍、孤立性左心室收缩功能障碍和双心室收缩功能障碍（钩端螺旋体病分别为：31.43%、18.42%、13.16%、10.53%；脓毒症综合征分别为：22.22%、12.00%、12.00%、8.00%（各比较组P>0.05））。钩端螺旋体病患者肌钙蛋白-T升高的趋势更明显（61.0% 对40.0%，P = 0.057）。ST段抬高和肌钙蛋白升高是钩端螺旋体病中左心室射血分数降低的独立预测因素。
钩端螺旋体病的心脏受累情况似乎与脓毒症综合征相似，心肌收缩功能障碍很常见。因此，对这些高危患者的心脏状况保持临床警惕至关重要。
