Nguyen Thanh H, Stansborough Jeanette, Ong Gao J, Surikow Sven, Price Timothy J, Horowitz John D
1Cardiology Unit, Department of Cardiology, The Queen Elizabeth Hospital, 28 Woodville Road, Woodville South, SA 5011 Australia.
2The University of Adelaide, Adelaide, Australia.
Cardiooncology. 2019 Nov 22;5:20. doi: 10.1186/s40959-019-0053-6. eCollection 2019.
Takotsubo syndrome (TTS), primarily an acute myocardial inflammatory condition engendered by catecholamine exposure, is associated with similar long-term mortality rates to those of patients with acute myocardial infarction. However, there is increasing evidence of a nexus between TTS and underlying malignancies:- many patients have antecedent cancer (A/Ca), while incremental risk of late cancer-related death has also been reported.
To evaluate potential interactions between A/Ca among TTS patients and both early and late clinical course.
Three hundred forty-six consecutive TTS patients [aged 69 ± 13 (SD) years, males: 8.2%] were prospectively followed up for a median duration of 4.1 (IQR 2.2-6.4) years. Associations between A/Ca and severity of acute attacks, in-hospital complications and long-term death rates were sought utilising univariate analyses followed by multiple logistic regression analysis.
A/Ca (present in 16.8% of patients) was associated with (i) greater elevation of hs-CRP and NT-proBNP concentrations ( = 0.01 and 0.04, respectively), (ii) more complicated in-hospital clinical course, with major adverse cardiac events (MACE) in 30.9% of patients, compared to 18.2% in non-A/Ca patients ( = 0.04). Long-term all-cause mortality rate was also greater [hazard ratio (HR) = 2.4, = 0.0001] in A/Ca patients, with an excess cardiovascular (CVS) fatality rate (HR = 3.1, = 0.001). On multivariate analysis, male gender, peak plasma concentrations of normetanephrine and hs-CRP, early arrhythmias and development of shock, but not A/Ca per se were all independently associated with increased long-term mortality rate. Furthermore, patients discharged on β-adrenoceptor antagonists (βBl) or angiotensin converting enzyme inhibitors/ angiotensin receptor blockers (ACEi/ARB) had lower long-term mortality rates (β = - 0.2, = 0.01; β = - 0.14, = 0.05, respectively).
(1) A/Ca is associated with greater clinical severity of initial TTS attacks and substantially greater long-term CVS-related as well as all-cause mortality.(2) Post-discharge therapy with either βBl or ACEi/ARB is associated with reductions in long-term mortality rates.Overall, the current data suggest operation of substantial interactions between neoplasia and TTS, both at the level of pathogenesis and of outcomes.
应激性心肌病（TTS）主要是一种因儿茶酚胺暴露引发的急性心肌炎症性疾病，其长期死亡率与急性心肌梗死患者相似。然而，越来越多的证据表明TTS与潜在恶性肿瘤之间存在联系：许多患者有癌症病史（A/Ca），同时也有报道称其晚期癌症相关死亡风险增加。
评估TTS患者中A/Ca与早期和晚期临床病程之间的潜在相互作用。
对346例连续的TTS患者[年龄69±13（标准差）岁，男性占8.2%]进行前瞻性随访，中位随访时间为4.1（四分位间距2.2 - 6.4）年。通过单因素分析，然后进行多因素逻辑回归分析，寻找A/Ca与急性发作严重程度、住院并发症和长期死亡率之间的关联。
A/Ca（16.8%的患者存在）与以下情况相关：（i）hs-CRP和NT-proBNP浓度升高幅度更大（分别为P = 0.01和0.04），（ii）住院临床病程更复杂，30.9%的患者发生主要不良心脏事件（MACE），而非A/Ca患者为18.2%（P = 0.04）。A/Ca患者的长期全因死亡率也更高[风险比（HR）= 2.4，P = 0.0001]，心血管（CVS）死亡率过高（HR = 3.1，P = 0.001）。多因素分析显示，男性、去甲变肾上腺素和hs-CRP的血浆峰值浓度、早期心律失常和休克的发生，但不是A/Ca本身，均与长期死亡率增加独立相关。此外，出院时使用β肾上腺素能受体拮抗剂（βBl）或血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（ACEi/ARB）的患者长期死亡率较低（β = -0.2，P = 0.01；β = -0.14，P = 0.05）。
（1）A/Ca与初始TTS发作的临床严重程度更高以及长期CVS相关和全因死亡率大幅增加相关。（2）出院后使用βBl或ACEi/ARB治疗与长期死亡率降低相关。总体而言，目前的数据表明肿瘤形成与TTS在发病机制和结局层面均存在显著相互作用。
