T 型反转对 Takotsubo 综合征结局的影响与急性冠状动脉综合征的比较。

Impact of T-inversion on the outcome of Takotsubo syndrome as compared to acute coronary syndrome.

机构信息

First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany.

German Center for Cardiovascular Research, DZHK Partner Site, Mannheim, Germany.

出版信息

Eur J Clin Invest. 2019 Apr;49(4):e13078. doi: 10.1111/eci.13078. Epub 2019 Feb 25.

DOI:10.1111/eci.13078

PMID:30725490

Abstract

BACKGROUND

Previous studies revealed that patients with Takotsubo syndrome (TTS) have a higher mortality rate than the general population and a comparable mortality to acute coronary syndrome (ACS). Repolarisation abnormalities, namely T-wave amplitude, may provide incremental prognostic information, in addition to traditional risk factors in ACS. This study was performed to determine the short- and long-term prognostic impact of inverted T-waves in TTS patients, as compared to ACS patients.

METHODS AND RESULTS

Our institutional database constituted a collective of 138 patients diagnosed with TTS from 2003 to 2017, as well as 532 patients suffering from ACS. Patients with TTS or with ACS (n = 138 per group) were matched for age and sex and assessed retrospectively and prospectively and divided into two groups, TTS with inverted T-waves (n = 123) and ACS with inverted T-waves (n = 80). In-hospital complications such as respiratory failure with the need of respiratory support (60.2% vs 6.3%; P < 0.01), thromboembolic events (13.8% vs 2.5%; P < 0.01) and cardiogenic shock (18.9% vs 8.8%; P = 0.05) were significantly more presented in TTS as compared to ACS patients. Among cardiovascular risk factors diabetes mellitus (23.6% vs 45.0%; P < 0.01) and arterial hypertension (57.7% vs 78.8%; P < 0.01) were more presented in ACS patients as compared to TTS patients. Short-term mortality was similar, however the long-term mortality of 5 years was significantly higher in the TTS group (25.2% vs 7.5%; P < 0.01). In univariate analysis were male gender, EF < 35%, GFR < 60 mL/min, cardiogenic shock, inotropic drugs and history of cancer predictors of 5-year mortality. The multivariate analysis showed only male gender (HR 2.7, 95% CI 1.1-6.5; P = 0.02), GFR < 60 mL/min (HR 2.8, 95% CI 1.2-6.0; P = 0.01) and history of cancer (HR 3.6, 95% CI 1.4-9.3; P < 0.01) as independent predictors of 5-year mortality.

CONCLUSION

Rates of long-term mortality were significantly higher in TTS patients showing inverted T-waves compared with patients diagnosed with ACS with inverted T-waves. However, T-inversion was not an independent predictor of 5-year mortality in the multivariate analysis.

摘要

背景

先前的研究表明，患有 Takotsubo 综合征（TTS）的患者死亡率高于普通人群，与急性冠状动脉综合征（ACS）相当。复极异常，即 T 波幅度，除了 ACS 的传统危险因素外，可能提供额外的预后信息。本研究旨在确定 TTS 患者与 ACS 患者相比，倒置 T 波的短期和长期预后影响。

方法和结果

我们的机构数据库由 2003 年至 2017 年间诊断为 TTS 的 138 例患者和 532 例 ACS 患者组成。将 TTS 或 ACS 患者（每组 138 例）按年龄和性别匹配，进行回顾性和前瞻性评估，并分为两组：TTS 伴倒置 T 波（n=123）和 ACS 伴倒置 T 波（n=80）。TTS 患者的住院并发症，如需要呼吸支持的呼吸衰竭（60.2%比 6.3%；P<0.01）、血栓栓塞事件（13.8%比 2.5%；P<0.01）和心源性休克（18.9%比 8.8%；P=0.05）明显多于 ACS 患者。与 TTS 患者相比，心血管危险因素糖尿病（23.6%比 45.0%；P<0.01）和动脉高血压（57.7%比 78.8%；P<0.01）在 ACS 患者中更为常见。短期死亡率相似，但 TTS 组 5 年的长期死亡率明显更高（25.2%比 7.5%；P<0.01）。单因素分析显示，男性、EF<35%、GFR<60mL/min、心源性休克、正性肌力药物和癌症史是 5 年死亡率的预测因素。多因素分析显示，只有男性（HR 2.7，95%CI 1.1-6.5；P=0.02）、GFR<60mL/min（HR 2.8，95%CI 1.2-6.0；P=0.01）和癌症史（HR 3.6，95%CI 1.4-9.3；P<0.01）是 5 年死亡率的独立预测因素。