First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.
DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany.
Intern Med J. 2019 Jun;49(6):770-776. doi: 10.1111/imj.14169.
Clinical variables that predict long-term mortality and recurrence of Takotsubo syndrome (TTS) are not completely understood as the role of acquired corrected QT interval (QTc) prolongation.
To detect the prevalence of QTc interval prolongation in patients with TTS and to evaluate its long-term prognostic impact.
QTc intervals were analysed in 105 patients presenting with symptoms of TTS. These patients were included in an ongoing retrospective cohort database. The cohort was subsequently subdivided into two groups based on the presence (long QT (LQT) group, n = 73, 69.52%) or absence (non-long QT (non-LQT) group, n = 32, 30.43%) of QTc interval prolongation. Patients were followed up over a mean period of 4.2 years. The rate of life-threatening arrhythmia during the first 30 days in the LQT group was comparable with the non-LQT group (10.9 vs 12.5%), whereas in-hospital mortality and 30-day mortality occurred less frequently in the LQT group (2.7 vs 18.75%, P < 0.01).
During this time span, 17 (23.3%) patients with acquired LQT syndrome died, whereas 14 (43.7%) patients with non-LQT duration died. Kaplan-Meier survival rates were significantly higher in the LQT group than those in the non-LQT group (Log-rank-test, P = 0.02). On multivariate analysis, the QTc interval was an independent negative predictor of all-cause mortality (P = 0.02).
The QTc interval at admission is an independent negative predictor of long-term adverse outcome in patients with TTS.
目前尚不完全了解临床变量是否可以预测 Takotsubo 综合征（TTS）的长期死亡率和复发率，而获得性校正 QT 间期（QTc）延长在此过程中的作用也并不明确。
检测 TTS 患者 QTc 间期延长的发生率，并评估其对长期预后的影响。
对 105 例出现 TTS 症状的患者进行 QTc 间期分析。这些患者被纳入正在进行的回顾性队列数据库中。根据是否存在 QTc 间期延长（长 QT（LQT）组，n=73，69.52%）或不存在 QTc 间期延长（非长 QT（non-LQT）组，n=32，30.43%）将队列分为两组。患者平均随访 4.2 年。LQT 组在第 30 天发生危及生命的心律失常的发生率与 non-LQT 组相当（10.9%比 12.5%），但 LQT 组院内死亡率和 30 天死亡率较低（2.7%比 18.75%，P<0.01）。
在此期间，17 例（23.3%）获得性 LQT 综合征患者死亡，而非 LQT 持续时间患者死亡 14 例（43.7%）。LQT 组的 Kaplan-Meier 生存率明显高于 non-LQT 组（Log-rank 检验，P=0.02）。多变量分析显示，QTc 间期是全因死亡率的独立负预测因子（P=0.02）。
入院时的 QTc 间期是 TTS 患者长期不良预后的独立负预测因子。
