Gandhi Zainab, Fong Hee Kong, Manaktala Pritika, Malik Faizan A, Savani Sejal, Gupta Neelesh, Desai Rupak
Internal Medicine, Geisinger Community Medical Center, Scranton, USA.
Cardiovascular Medicine, University of California Davis Medical Center, Sacramento, USA.
Cureus. 2020 Aug 21;12(8):e9925. doi: 10.7759/cureus.9925.
Background Systemic Sclerosis (SSc) is associated with chronic inflammation which leads to macrophage activation and thus vascular insult and fibrosis. Macrophage activation is shown to precede Takotsubo syndrome (TTS) which may be a common pathophysiologic link to SSc. Methods We queried the National Inpatient Sample (2008-2014) for adult SSc-related hospitalizations and TTS using relevant International Classification of Diseases Clinical Modification, 9th Revision codes. We assessed the prevalence and trends in TTS during this time. We further assessed demographics, comorbidities, and outcomes were in SSc with and without TTS. The primary outcomes of the analysis were all-cause mortality and in-hospital complications including cardiac arrest and acute myocardial infarction (AMI), arrhythmias, and venous thromboembolism, and stroke. Results A total of 213,728 SSc-related hospitalizations were found, of which 357 experienced TTS (0.2%) with rising trends in TTS from 2008-2014 (0.06% to 0.3%, relative increase of 24%, p<0.001). The TTS cohort was older (median age 68 vs 62 years), with 92.8% females and 80.1% white adults with TTS (p<0.001). Co-morbidities were higher in the TTS cohort including hypertension (62.2% vs. 51.5%, p<0.001), dyslipidemia (41.5% vs. 22.8, p<0.001), smoking (28.9% vs. 20.1%, p<0.001), peripheral vascular disease (17.8% vs. 9.1%, p<0.001), uncomplicated diabetes (18.1% vs. 11.9%, p<0.001). The all-cause in-hospital mortality (11% vs. 4.6%; adjusted odds ratio=1.82, 95% confidence interval: 1.21-2.72, p<0.005), cardiovascular complications like AMI (29% vs. 2.9%,p<0.001), arrhythmias (38.9% vs. 21.5%, p<0.001), and median length of stay [6 vs. 4 days] were significantly higher in the TTS cohort as compared to the non-TTS cohort. Conclusion This analysis revealed a nearly 10 times higher prevalence of TTS in SSc-related hospitalizations compared to the general inpatient population. Concomitant TTS occurrence in SSc-related hospitalizations led to nearly two times higher odds of all-cause mortality. Cardiovascular co-morbidities in SSc may increase the risk of TTS and worsened outcomes.
系统性硬化症（SSc）与慢性炎症相关，慢性炎症会导致巨噬细胞活化，进而引起血管损伤和纤维化。研究表明，巨噬细胞活化先于应激性心肌病（TTS）出现，这可能是SSc的一个常见病理生理联系。方法：我们使用相关的国际疾病分类临床修订版第9版编码，在国家住院样本（2008 - 2014年）中查询成年SSc相关住院病例和TTS病例。我们评估了这段时间内TTS的患病率和趋势。我们还进一步评估了有和没有TTS的SSc患者的人口统计学特征、合并症及预后情况。分析的主要结局指标为全因死亡率和院内并发症，包括心脏骤停、急性心肌梗死（AMI）、心律失常、静脉血栓栓塞和中风。结果：共发现213,728例SSc相关住院病例，其中357例发生了TTS（0.2%），2008 - 2014年TTS呈上升趋势（从0.06%升至0.3%，相对增加24%，p<0.001）。TTS患者队列年龄更大（中位年龄68岁对62岁），TTS患者中92.8%为女性，80.1%为白人成年人（p<0.001）。TTS患者队列的合并症更多，包括高血压（62.2%对51.5%，p<0.001）、血脂异常（41.5%对22.8%，p<0.001）、吸烟（28.9%对20.1%，p<0.001）、外周血管疾病（17.8%对9.1%，p<0.001）、单纯性糖尿病（18.1%对11.9%，p<0.001）。与非TTS队列相比，TTS队列的全因院内死亡率更高（11%对4.6%；调整后的优势比 = 1.82，95%置信区间：1.21 - 2.72，p<0.005），心血管并发症如AMI（29%对2.9%，p<0.001）、心律失常（38.9%对21.5%，p<0.001）以及中位住院时间[6天对4天]也显著更高。结论：该分析显示，与普通住院患者群体相比，SSc相关住院病例中TTS的患病率高出近10倍。SSc相关住院病例中同时发生TTS导致全因死亡率高出近两倍。SSc患者的心血管合并症可能会增加TTS的风险并使预后恶化。
