Ludhwani Dipesh, Rahaby Mouyyad, Patel Vasu, Jamil Saad, Kedzia Adam, Wu Chunyi
Chicago Medical School, Rosalind Franklin University, Northwestern McHenry Hospital, 4309 West Medical Center Drive, McHenry, IL, 60050, USA.
University of Michigan, 500 S State St, Ann Arbor, MI, 48109, USA.
Cardiol Ther. 2019 Dec;8(2):253-265. doi: 10.1007/s40119-019-0141-6. Epub 2019 Jul 17.
Takotsubo cardiomyopathy (TTC), also called stress cardiomyopathy, is a transient reversible left ventricular dysfunction mimicking acute coronary syndrome (ACS). Studies have shown similar rates of in-hospital complications in TTC and myocardial infarction (MI). Left bundle branch block (LBBB) is associated with increased mortality in patients with MI; however, similar studies comparing outcomes of TTC in the presence of LBBB are lacking.
The 2016 National Inpatient Sample (NIS) database was queried to identify all admissions with a primary discharge diagnosis of TTC. Diagnosis-specific codes were used to stratify patients based on the presence or absence of LBBB. Both population sets were paired using 1:10 propensity score matching. Multivariate logistic regression analysis was performed to compare various in-hospital outcomes among both groups.
Amongst 7270 admissions for TTC, 226 patients had concomitant LBBB. After performing 1:10 propensity matching, 130 patients with LBBB were compared to 1275 patients without LBBB. The presence of LBBB was associated with increased odds of cardiogenic shock (AOR = 2.2, 95% CI 1.21-3.99, p = 0.0097); ventricular arrhythmia (AOR 1.99, 95% CI 1.11-3.57, p = 0.02), acute congestive heart failure (AOR = 1.49, 95% CI 1.01-2.2, p = 0.04), and sudden cardiac arrest (AOR = 3.37, 95% CI 1.59-7.13, p = 0.0001). There was no statistical difference in all-cause in-hospital mortality, however a trend towards worsening was noted.
The incidence of arrhythmia and shock in patients with TTC does not correlate with the extent of myocardium involvement. The presence of LBBB in such cases can help recognize at-risk populations, and with timely intervention, life-threatening complications can be avoided. Despite limitations of the dataset and inability to establish causality, prospective studies with longer follow-up are warranted.
应激性心肌病（TTC），也称为应激性心肌病，是一种模仿急性冠状动脉综合征（ACS）的短暂可逆性左心室功能障碍。研究表明，TTC和心肌梗死（MI）的院内并发症发生率相似。左束支传导阻滞（LBBB）与MI患者的死亡率增加有关；然而，缺乏比较存在LBBB时TTC结局的类似研究。
查询2016年全国住院患者样本（NIS）数据库，以识别所有以TTC为主要出院诊断的入院病例。使用诊断特定代码根据是否存在LBBB对患者进行分层。两组人群均采用1:10倾向评分匹配。进行多变量逻辑回归分析以比较两组之间的各种院内结局。
在7270例TTC入院病例中，226例患者伴有LBBB。进行1:10倾向匹配后，将130例LBBB患者与1275例无LBBB患者进行比较。LBBB的存在与心源性休克几率增加相关（调整后比值比[AOR]=2.2，95%置信区间[CI]1.21-3.99，p=0.0097）；室性心律失常（AOR 1.99，95%CI 1.11-3.57，p=0.02）、急性充血性心力衰竭（AOR=1.49，95%CI 1.01-2.2，p=0.04）和心搏骤停（AOR=3.37，95%CI 1.59-7.13，p=0.0001）。全因院内死亡率无统计学差异，但有恶化趋势。
TTC患者心律失常和休克的发生率与心肌受累程度无关。此类病例中LBBB的存在有助于识别高危人群，通过及时干预可避免危及生命的并发症。尽管数据集存在局限性且无法确定因果关系，但仍需要进行随访时间更长的前瞻性研究。
