Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany; German Center for Cardiovascular Research, Partner Site Hamburg-Kiel-Lübeck, Lübeck, Germany.
Medical Clinic II, University Heart Center Lübeck, Lübeck, Germany.
JACC Heart Fail. 2022 Jul;10(7):459-466. doi: 10.1016/j.jchf.2022.02.015. Epub 2022 May 4.
The association with a preceding stressor is a characteristic feature of takotsubo syndrome (TTS). Negative emotions before TTS are common and led to the popular term "broken heart syndrome." In contrast, pleasant triggers ("happy heart syndrome") are rare and are scarcely investigated.
The authors analyzed the frequency, clinical characteristics, and prognostic implications of positive emotional stressors in the multicenter GEIST (GErman-Italian-Spanish Takotsubo) Registry.
Patients enrolled in the registry were categorized according to their stressors. This analysis compared patients with pleasant emotional events with patients with negative emotional events.
Of 2,482 patients in the registry, 910 patients (36.7%) exhibited an emotional trigger consisting of 873 "broken hearts" (95.9%) and 37 "happy hearts" (4.1%). Consequently, the prevalence of pleasant emotional triggers was 1.5% of all TTS cases. Compared with patients with TTS with negative preceding events, patients with happy heart syndrome were more frequently male (18.9% vs 5.0%; P < 0.01) and had a higher prevalence of atypical ballooning patterns (27.0% vs 12.5%; P = 0.01), particularly midventricular ballooning. In-hospital complications, including death, pulmonary edema, cardiogenic shock, or stroke (8.1% vs 12.3%; P = 0.45), and long-term mortality rates (2.7% vs 8.8%; P = 0.20) were similar in "happy hearts" and "broken hearts."
Happy heart syndrome is a rare type of TTS characterized by a higher prevalence of male patients and atypical, nonapical ballooning compared with patients with negative emotional stressors. Despite similar short- and long-term outcomes in our study, additional data are needed to explore whether numerically lower event rates in "happy hearts" would be statistically significant in a larger sample size. (GErman-Italian-Spanish Takotsubo Registry [GEIST Registry]; NCT04361994).
先前应激源的关联性是心尖球囊样综合征（TTS）的特征之一。TTS 前常见负性情绪，并导致了“心碎综合征”这一流行术语。相比之下，愉悦性触发因素（“开心心综合征”）则很少见，且鲜少受到研究。
作者分析了多中心 GEIST（德国-意大利-西班牙 Takotsubo）注册研究中 TTS 患者正性情绪应激源的频率、临床特征和预后意义。
根据应激源对注册患者进行分类。该分析比较了具有愉悦性情绪事件的患者与具有负性情绪事件的患者。
在该注册研究的 2482 例患者中，910 例（36.7%）存在情绪触发因素，包括 873 例“心碎”（95.9%）和 37 例“开心心”（4.1%）。因此，愉悦性情绪触发因素的发生率为所有 TTS 病例的 1.5%。与具有先前负性事件的 TTS 患者相比，“开心心”患者更常为男性（18.9%比 5.0%；P < 0.01），且非典型性气球样变的发生率更高（27.0%比 12.5%；P = 0.01），特别是中心室气球样变。院内并发症包括死亡、肺水肿、心源性休克或卒中等（8.1%比 12.3%；P = 0.45），以及长期死亡率（2.7%比 8.8%；P = 0.20）在“开心心”和“心碎”患者中相似。
“开心心”综合征是一种罕见类型的 TTS，其特征为男性患者比例较高，与具有负性情绪应激源的患者相比，非典型性、非心尖气球样变更为常见。尽管本研究中短期和长期结局相似，但需要更多数据来探讨“开心心”患者中发生率略低的事件是否在更大的样本量中具有统计学意义。（德国-意大利-西班牙 Takotsubo 注册研究[GEIST 注册研究]；NCT04361994）
