Matsushita Kensuke, Lachmet-Thébaud Lucie, Marchandot Benjamin, Trimaille Antonin, Sato Chisato, Dagrenat Charlotte, Greciano Stephane, De Poli Fabien, Leddet Pierre, Peillex Marilou, Hess Sébastien, Carmona Adrien, Jimenez Charline, Heger Joe, Reydel Antje, Ohlmann Patrick, Jesel Laurence, Morel Olivier
Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire.
UMR INSERM 1260 Regenerative Nanomedicine, Université de Strasbourg.
Circ J. 2021 Sep 24;85(10):1823-1831. doi: 10.1253/circj.CJ-20-1116. Epub 2021 Apr 6.
Although there is an apparent rapid and spontaneous recovery of left ventricular ejection fraction (LVEF) in patients with Takotsubo syndrome (TTS), recent studies have demonstrated a long-lasting functional impairment in those patients. The present study sought to evaluate the predictors of incomplete recovery following TTS and its impact on cardiovascular mortality.
Patients with TTS between 2008 and 2018 were retrospectively enrolled at 3 different institutions. After exclusion of in-hospital deaths, 407 patients were split into 2 subgroups according to whether their LVEF was >50% (recovery group; n=341), or ≤50% (incomplete recovery group; n=66) at the chronic phase. Multivariate logistic regression analysis found that LVEF (odds ratio [OR]: 0.94; 95% confidence interval [CI]: 0.91-0.98; P<0.001) and C-reactive protein levels (OR: 1.11; 95% CI: 1.02-1.22; P=0.02) at discharge were independent predictors of incomplete recovery. At a median follow up of 52 days, a higher cardiovascular mortality was evident in the incomplete recovery group (16% vs. 0.6%; P<0.001).
This study demonstrated that incomplete recovery after TTS is characterized by residual systemic inflammation and an increased cardiac mortality at follow up. Altogether, the present study findings determined that patients with persistent inflammation are a high-risk subgroup, and should be targeted in future clinical trials with specific therapies to attenuate inflammation.
虽然Takotsubo综合征（TTS）患者的左心室射血分数（LVEF）有明显快速且自发的恢复，但最近的研究表明这些患者存在长期的功能损害。本研究旨在评估TTS后恢复不完全的预测因素及其对心血管死亡率的影响。
对2008年至2018年间3家不同机构的TTS患者进行回顾性纳入。排除院内死亡患者后，407例患者根据慢性期LVEF是否>50%（恢复组；n = 341）或≤50%（恢复不完全组；n = 66）分为2个亚组。多因素逻辑回归分析发现，出院时的LVEF（比值比[OR]：0.94；95%置信区间[CI]：0.91 - 0.98；P < 0.001）和C反应蛋白水平（OR：1.11；95% CI：1.02 - 1.22；P = 0.02）是恢复不完全的独立预测因素。在中位随访52天时，恢复不完全组的心血管死亡率更高（16%对0.6%；P < 0.001）。
本研究表明，TTS后恢复不完全的特征是残留全身炎症以及随访时心脏死亡率增加。总之，本研究结果确定持续炎症患者是高危亚组，在未来临床试验中应以特定疗法减轻炎症为目标。
