Matsuura Takero, Ueno Masafumi, Iwanaga Yoshitaka, Miyazaki Shunichi
Division of Cardiology, Department of Medicine, Faculty of Medicine, Kindai University, 377-2 Ohnohigashi, Osakasayama, Osaka, 589-8511, Japan.
Heart Vessels. 2019 Aug;34(8):1317-1324. doi: 10.1007/s00380-019-01359-4. Epub 2019 Feb 22.
The relationship between activation of the sympathetic nervous system (SNS) and improvement of left ventricular (LV) function and how this correlates with clinical outcomes are not fully explored in Takotsubo syndrome (TS). The purpose of this study is to evaluate the relationship between activation of the SNS and LV function improvement and how this correlates with clinical outcomes in TS. Patients with TS were retrospectively identified. Patients were divided into two groups according to the timing of LV function improvement: < 1 month (S group) and ≥ 1 month (L group). Activation of the SNS was assessed by plasma catecholamine measurement and Iodine-123 meta-iodobenzylguanidine (I-MIBG) scintigraphy. In-hospital complications included heart failure, cardiogenic shock, the use of invasive or noninvasive ventilation, life-threatening arrhythmia, cerebrovascular event and all-cause death. A total of 90 patients with TS were enrolled. Of these, 39 patients were in the S group and 51 in the L group. There were no significant differences between the two groups in clinical demographics. The L group was characterized by enhanced SNS activation, including higher levels of catecholamines and lower late heart-mediastinum ratio followed by higher washout rate in I-MIBG scintigraphy, compared with the S group. In-hospital complications were increased in the L group (56% vs. 33.3%, p = 0.03), including higher rates of heart failure (45% vs. 23%, p = 0.03) and in-hospital death (8.0% vs. 0%, p = 0.03). In patients with TS, high activity of the SNS was observed in patients with delayed LV function recovery, which was associated with in-hospital adverse outcomes.
在应激性心肌病（TS）中，交感神经系统（SNS）激活与左心室（LV）功能改善之间的关系以及这与临床结局的相关性尚未得到充分研究。本研究的目的是评估SNS激活与LV功能改善之间的关系以及这与TS临床结局的相关性。对TS患者进行回顾性识别。根据LV功能改善的时间将患者分为两组：<1个月（S组）和≥1个月（L组）。通过血浆儿茶酚胺测量和碘-123间碘苄胍（I-MIBG）闪烁显像评估SNS的激活情况。住院并发症包括心力衰竭、心源性休克、使用有创或无创通气、危及生命的心律失常、脑血管事件和全因死亡。共纳入90例TS患者。其中，39例患者在S组，51例在L组。两组在临床人口统计学方面无显著差异。与S组相比，L组的特点是SNS激活增强，包括儿茶酚胺水平较高、晚期心纵隔比值较低，随后I-MIBG闪烁显像的洗脱率较高。L组的住院并发症增加（56%对33.3%，p=0.03），包括更高的心力衰竭发生率（45%对23%，p=0.03）和住院死亡率（8.0%对0%，p=0.03）。在TS患者中，LV功能恢复延迟的患者观察到SNS高活性，这与住院不良结局相关。
