Mariani Silvia, Richter Jannik, Pappalardo Federico, Bělohlávek Jan, Lorusso Roberto, Schmitto Jan D, Bauersachs Johann, Napp L Christian
Department of Cardiothoracic, Transplantation and Vascular Surgery, Hannover Medical School, Hannover, Germany.
Cardiac Arrest Center, Advanced Heart Failure Unit, Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
Int J Cardiol. 2020 Oct 1;316:31-39. doi: 10.1016/j.ijcard.2020.05.033. Epub 2020 May 28.
Cardiogenic shock occurs in 10%-15% of patients with Takotsubo syndrome (TS). For several reasons catecholamines, and especially inotropes, should be avoided in TS. Temporary mechanical circulatory support (MCS) appears attractive as bridge-to-recovery, but prospective studies are lacking. Here we analyze the available literature on MCS use in patients with TS.
PubMed/Medline was systematically screened until December 2019. 18 studies reporting pooled data of 5629 TS patients, of whom 227 had received MCS, were considered for a qualitative synthesis. 81 articles from 2003 through 2019 reporting individual data of 93 MCS cases were included in a meta-analysis. Median age was 57 (IQR: 43-68) years, 83.9% were women, and a physical trigger could be identified in 74.1% of cases. Median left ventricular ejection fraction (LVEF) before MCS was 20% (IQR: 15-25) and comparable between groups defined by MCS device. An apical TS type was present in 76.1% of cases. The overall number of publications on MCS for TS increased over time, as did those using veno-arterial extracorporeal membrane oxygenation (V-A ECMO) and Impella, while those using intra-aortic balloon pump declined. MCS-related complications were not regularly reported. Median time on MCS was 3 (IQR: 2-7) days, with an overall survival of 94.6%.
MCS for TS-related shock is increasingly reported, with a growing use of V-A ECMO and Impella. Currently available clinical data support this approach. Prospective studies are needed to evaluate safety and efficacy of different devices as well as timing of MCS in this special patient population.
Takotsubo综合征（TS）患者中10%-15%会发生心源性休克。由于多种原因，TS患者应避免使用儿茶酚胺类药物，尤其是正性肌力药物。临时机械循环支持（MCS）作为过渡到康复的手段似乎很有吸引力，但缺乏前瞻性研究。在此，我们分析了关于TS患者使用MCS的现有文献。
系统检索PubMed/Medline直至2019年12月。18项报告5629例TS患者汇总数据的研究被纳入定性分析，其中227例接受了MCS。2003年至2019年报告93例MCS病例个体数据的81篇文章被纳入荟萃分析。中位年龄为57岁（四分位间距：43-68岁），83.9%为女性，74.1%的病例可确定有身体触发因素。MCS前左心室射血分数（LVEF）中位数为20%（四分位间距：15%-25%），在按MCS装置定义的组间具有可比性。76.1%的病例为心尖型TS。关于TS使用MCS的总体出版物数量随时间增加，使用静脉-动脉体外膜肺氧合（V-A ECMO）和Impella的出版物数量也增加，而使用主动脉内球囊泵的出版物数量下降。未定期报告MCS相关并发症。MCS的中位时间为3天（四分位间距：2-7天），总体生存率为94.6%。
越来越多的报告称TS相关休克使用MCS，V-A ECMO和Impella的使用也在增加。目前可得的临床数据支持这种方法。需要进行前瞻性研究以评估不同装置的安全性和有效性以及在这一特殊患者群体中MCS的时机。
