Dipartimento di Scienze Cardiovascolari e Toraciche, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Largo Agostino Gemelli 8, Rome, Italy.
Istituto di Cardiologia, Università Cattolica del Sacro Cuore, Rome, Italy.
J Cardiovasc Med (Hagerstown). 2021 Mar 1;22(3):180-189. doi: 10.2459/JCM.0000000000001106.
To investigate predictors of the occurrence of subacute ventricular arrhythmias (VAs), defined as any VAs presenting after 48 h from admission in patients with Takotsubo Syndrome (TTS), and to evaluate the related in-hospital mortality.
This is a retrospective single-center study enrolling patients admitted between 2012 and 2017 with TTS according to International Takotsubo diagnostic criteria. Data collection included ECG on admission and at 48 h, telemetry monitoring and transthoracic echocardiogram.
We enrolled 93 patients; during in-hospital stay (mean 14 ± 16 days) subacute VAs occurred in 25% of patients (VAs group). Life-threatening VAs occurred in 6% of patients (3 sustained ventricular tachycardia, 1 torsade de pointes, 1 ventricular fibrillation) and not life-threatening VAs in 19% (6 non-sustained ventricular tachycardia and 12 premature ventricular contractions > 2000 in 24 h). Mortality was higher in the VAs than in the non-VAs group (P = 0.03), without differences in terms of life-threatening and not life-threatening subacute VAs (P = 0.65) and VAs on admission (P = 0.25). Logistic regression identified the following independent predictors of subacute VAs occurrence: VAs on admission {odds ratio [OR] 22.5 (3.9-131.8), P = 0.001]}, New York Heart Association (NYHA) class III-IV on admission [OR 6.7 (1.3- 34.0), P = 0.021] and QTc at 48 h [OR 1.01 (1.00-1.03), P = 0.046].
TTS patients with VAs and NYHA class III-IV on admission and higher QTc at 48 h are at increased risk of subacute VAs occurrence, associated with higher in-hospital mortality. Awareness of this potential complication is critical for proper patients management.
研究急性室性心律失常（VA）发生的预测因素，急性室性心律失常定义为在 Takotsubo 综合征（TTS）患者入院后 48 小时内出现的任何 VA；并评估相关的院内死亡率。
这是一项回顾性单中心研究，纳入了 2012 年至 2017 年根据国际 Takotsubo 诊断标准收治的 TTS 患者。数据收集包括入院时和入院后 48 小时的心电图、遥测监测和经胸超声心动图。
共纳入 93 例患者；在住院期间（平均 14±16 天），25%的患者出现亚急性 VA（VA 组）。6%的患者发生危及生命的 VA（3 例持续性室性心动过速、1 例尖端扭转型室性心动过速、1 例心室颤动），19%的患者发生非危及生命的 VA（6 例非持续性室性心动过速和 12 例 24 小时内室性早搏＞2000 次）。VA 组的死亡率高于非 VA 组（P=0.03），但危及生命和非危及生命的亚急性 VA 以及入院时的 VA 之间无差异（P=0.65）。多因素 logistic 回归分析确定亚急性 VA 发生的独立预测因素为：入院时 VA（比值比[OR]22.5（3.9-131.8），P=0.001]）、入院时 NYHA 心功能分级 III-IV 级（OR 6.7（1.3-34.0），P=0.021）和 48 小时时 QTc（OR 1.01（1.00-1.03），P=0.046）。
入院时伴有 VA 和 NYHA 心功能分级 III-IV 级以及 48 小时时 QTc 较高的 TTS 患者发生亚急性 VA 的风险增加，且院内死亡率较高。对这种潜在并发症的认识对于患者的适当管理至关重要。
