Division of Cardiology, State University of New York, USA.
Division of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, China.
Eur Heart J Acute Cardiovasc Care. 2020 Oct;9(7):711-720. doi: 10.1177/2048872620926680. Epub 2020 Jun 8.
Myocardial infarction can be a trigger of Takotsubo syndrome. We recently characterized imaging features of acute myocardial infarction-induced Takotsubo syndrome ("Takotsubo effect"). In this study, we investigate diagnostic and prognostic implications of Takotsubo effect in patients with anterior wall ST-segment elevation myocardial infarction.
We enrolled 111 consecutive patients who developed anterior wall ST-segment elevation myocardial infarction and received percutaneous coronary intervention, and studied systolic/diastolic function, hemodynamic consequences, adverse cardiac events, as well as 30-day and five-year outcomes in patients with and without Takotsubo effect.
Patients with Takotsubo effect showed significantly worse average peak systolic longitudinal strain (-9.5 ± 2.6% vs -11.1 ± 3.6%, = 0.038), left ventricular ejection fraction (38.5 ± 6.8% vs 47.7 ± 8.7%, = 0.000) and myocardial performance index (0.54 ± 0.17 vs 0.37 ± 0.15, = 0.000) within 48 h of myocardial infarction. There was no significant difference between the two groups in diastolic ventricular filling pressures, hemodynamic consequences, and 30-day rehospitalization and mortality (Gehan-Breslow-Wilcoxon test: 0.157). However, patients with Takotsubo effect developed more major adverse cardiac events (log-rank test: 0.019) when tested at the five-year follow-up. Cox regression analysis revealed that age, hypotension, tricuspid annular plane systolic excursion, and Takotsubo effect were independent prediction factors for five-year major adverse cardiac events. The Doppler/tissue Doppler parameter E/e' correlated with MACE only in patients without Takotsubo effect.
Takotsubo effect secondary to anterior ST-segment elevation myocardial infarction predicts a worse long-term prognosis.
心肌梗死可引发 Takotsubo 综合征。我们最近对急性心肌梗死后 Takotsubo 综合征（Takotsubo 效应）的影像学特征进行了描述。本研究旨在探讨前壁 ST 段抬高型心肌梗死患者中 Takotsubo 效应的诊断和预后意义。
我们连续纳入了 111 例接受经皮冠状动脉介入治疗的前壁 ST 段抬高型心肌梗死患者，研究了有和无 Takotsubo 效应患者的收缩/舒张功能、血流动力学后果、不良心脏事件以及 30 天和 5 年结局。
Takotsubo 效应患者的平均峰值收缩纵向应变明显更差（-9.5±2.6% vs -11.1±3.6%，=0.038）、左心室射血分数更低（38.5±6.8% vs 47.7±8.7%，=0.000）和心肌做功指数更高（0.54±0.17 vs 0.37±0.15，=0.000），均在心肌梗死后 48 h 内。两组患者的舒张心室充盈压、血流动力学后果、30 天再住院率和死亡率无显著差异（Gehan-Breslow-Wilcoxon 检验：0.157）。然而，在 5 年随访时，Takotsubo 效应患者发生更多的主要不良心脏事件（对数秩检验：0.019）。Cox 回归分析显示，年龄、低血压、三尖瓣环平面收缩位移和 Takotsubo 效应是 5 年主要不良心脏事件的独立预测因素。多普勒/组织多普勒参数 E/e'仅在前壁 ST 段抬高型心肌梗死无 Takotsubo 效应患者中与 MACE 相关。
前壁 ST 段抬高型心肌梗死后发生的 Takotsubo 效应预示着更差的长期预后。
