Napp L Christian, Cammann Victoria L, Jaguszewski Milosz, Szawan Konrad A, Wischnewsky Manfred, Gili Sebastiano, Knorr Maike, Heiner Susanne, Citro Rodolfo, Bossone Eduardo, D'Ascenzo Fabrizio, Neuhaus Michael, Franke Jennifer, Sorici-Barb Ioana, Noutsias Michel, Burgdorf Christof, Koenig Wolfgang, Kherad Behrouz, Sarcon Annahita, Rajan Lawrence, Michels Guido, Pfister Roman, Cuneo Alessandro, Jacobshagen Claudius, Karakas Mahir, Pott Alexander, Meyer Philippe, Arroja Jose D, Banning Adrian, Cuculi Florim, Kobza Richard, Fischer Thomas A, Vasankari Tuija, Airaksinen K E Juhani, Hauck Christian, Paolini Carla, Bilato Claudio, Imori Yoichi, Kato Ken, Kobayashi Yoshio, Opolski Grzegorz, Budnik Monika, Dworakowski Rafal, MacCarthy Philip, Kaiser Christoph, Osswald Stefan, Galiuto Leonarda, Dichtl Wolfgang, Chan Christina, Bridgman Paul, Beug Daniel, Delmas Clément, Lairez Olivier, El-Battrawy Ibrahim, Akin Ibrahim, Gilyarova Ekaterina, Shilova Alexandra, Gilyarov Mikhail, Horowitz John D, Polednikova Karolina, Tousek Petr, Widimský Petr, Winchester David E, Galuszka Jan, Ukena Christian, Poglajen Gregor, Carrilho-Ferreira Pedro, Di Mario Carlo, Prasad Abhiram, Rihal Charanjit S, Schulze P Christian, Bianco Matteo, Crea Filippo, Borggrefe Martin, Maier Lars S, Pinto Fausto J, Braun-Dullaeus Ruediger C, Rottbauer Wolfgang, Katus Hugo A, Hasenfuß Gerd, Tschöpe Carsten, Pieske Burkert M, Thiele Holger, Schunkert Heribert, Böhm Michael, Felix Stephan B, Münzel Thomas, Bax Jeroen J, Bauersachs Johann, Braunwald Eugene, Lüscher Thomas F, Ruschitzka Frank, Ghadri Jelena R, Templin Christian
Department of Cardiology and Angiology, Hannover Medical School, Hannover, Germany.
University Heart Center, Department of Cardiology, University Hospital Zurich, Raemistrasse 100, 8091 Zurich, Switzerland.
Eur Heart J. 2020 Sep 7;41(34):3255-3268. doi: 10.1093/eurheartj/ehaa210.
Takotsubo syndrome (TTS) is an acute heart failure syndrome, which shares many features with acute coronary syndrome (ACS). Although TTS was initially described with angiographically normal coronary arteries, smaller studies recently indicated a potential coexistence of coronary artery disease (CAD) in TTS patients. This study aimed to determine the coexistence, features, and prognostic role of CAD in a large cohort of patients with TTS.
Coronary anatomy and CAD were studied in patients diagnosed with TTS. Inclusion criteria were compliance with the International Takotsubo Diagnostic Criteria for TTS, and availability of original coronary angiographies with ventriculography performed during the acute phase. Exclusion criteria were missing views, poor quality of angiography loops, and angiography without ventriculography. A total of 1016 TTS patients were studied. Of those, 23.0% had obstructive CAD, 41.2% had non-obstructive CAD, and 35.7% had angiographically normal coronary arteries. A total of 47 patients (4.6%) underwent percutaneous coronary intervention, and 3 patients had acute and 8 had chronic coronary artery occlusion concomitant with TTS, respectively. The presence of CAD was associated with increased incidence of shock, ventilation, and death from any cause. After adjusting for confounders, the presence of obstructive CAD was associated with mortality at 30 days. Takotsubo syndrome patients with obstructive CAD were at comparable risk for shock and death and nearly at twice the risk for ventilation compared to an age- and sex-matched ACS cohort.
Coronary artery disease frequently coexists in TTS patients, presents with the whole spectrum of coronary pathology including acute coronary occlusion, and is associated with adverse outcome.
ClinicalTrials.gov number: NCT01947621.
应激性心肌病（TTS）是一种急性心力衰竭综合征，与急性冠状动脉综合征（ACS）有许多共同特征。尽管TTS最初被描述为冠状动脉造影正常，但最近的小型研究表明TTS患者可能并存冠状动脉疾病（CAD）。本研究旨在确定一大群TTS患者中CAD的并存情况、特征及预后作用。
对诊断为TTS的患者进行冠状动脉解剖及CAD研究。纳入标准为符合国际TTS诊断标准，且有急性期进行的原始冠状动脉造影及心室造影。排除标准为图像缺失、造影环质量差及无心室造影的造影。共研究了1016例TTS患者。其中，23.0%有阻塞性CAD，41.2%有非阻塞性CAD，35.7%冠状动脉造影正常。共有47例患者（4.6%）接受了经皮冠状动脉介入治疗，3例患者急性冠状动脉闭塞，8例患者慢性冠状动脉闭塞与TTS并存。CAD的存在与休克、通气及任何原因导致的死亡发生率增加相关。校正混杂因素后，阻塞性CAD的存在与30天死亡率相关。与年龄和性别匹配的ACS队列相比，患有阻塞性CAD的TTS患者发生休克和死亡的风险相当，通气风险几乎高出两倍。
CAD在TTS患者中经常并存，表现为包括急性冠状动脉闭塞在内的全谱冠状动脉病变，并与不良预后相关。
ClinicalTrials.gov编号：NCT01947621。
