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美国妊娠相关性应激性心肌病住院治疗情况。

Pregnancy-associated takotsubo cardiomyopathy hospitalizations in the United States.

机构信息

Center for Research Development and Scholarship, Vanderbilt University School of Nursing, Nashville, Tennessee, United States.

Department of Obstetrics and Gynecology, Vanderbilt University Medical Center, Nashville, Tennessee, United States.

出版信息

Am J Physiol Heart Circ Physiol. 2023 Sep 1;325(3):H468-H474. doi: 10.1152/ajpheart.00262.2023. Epub 2023 Jul 7.

Abstract

Takotsubo cardiomyopathy (TCM) is most common not only in postmenopausal women aged ≥50 yr but also in pregnant individuals. However, there are no national estimates on the prevalence, timing of occurrence, correlates, and outcomes of pregnancy-associated TCM. Using the Nationwide Inpatient Sample (NIS: 2016-2020), we describe rates of pregnancy-associated TCM hospitalizations among 13- to 49-yr-old pregnant individuals in the United States by selected demographic, behavioral, hospital, and clinical characteristics. Joinpoint regression was used to describe the annual average percent change of pregnancy-associated TCM hospitalizations. Survey logistic regression was used to measure the association of pregnancy-associated TCM hospitalizations with maternal outcomes. Of the 19,754,535 pregnancy-associated hospitalizations, 590 were TCM associated. The overall trend in pregnancy-associated TCM hospitalizations remained stable during the study period. The majority of TCM occurred during the postpartum, followed by antepartum and delivery-associated hospitalizations. When compared with pregnancy hospitalizations without TCM, those with TCM were more likely to be over the age of 35 yr and use tobacco and opioids. Comorbidities during TCM-associated pregnancy hospitalizations included heart failure, coronary artery disease, hemorrhagic stroke, and hypertension. After controlling for potential confounders, the odds of pregnancy-associated TCM hospitalizations were 98.7 times [adjusted odds ratio (aOR) = 98.66, 95% confidence interval (CI) 31.23-311.64] and 14.7 times (aOR = 14.75, 95% CI 9.99-21.76) higher for experiencing in-hospital mortality and a prolonged hospital stay, respectively, than those without TCM. Although rare, pregnancy-associated TCM hospitalization is more likely to occur during the postpartum period and is associated with in-hospital mortality and prolonged hospital stay. Although rare, pregnancy-associated takotsubo cardiomyopathy hospitalizations are more likely to occur during the postpartum period and are associated with in-hospital mortality and prolonged hospital stay.

摘要

心尖球囊样综合征(TCM)不仅常见于 50 岁以上的绝经后女性,也常见于孕妇。然而,目前尚没有关于妊娠相关 TCM 的患病率、发生时间、相关因素和结局的全国性估计。利用全国住院患者样本(NIS:2016-2020 年),我们按选定的人口统计学、行为、医院和临床特征,描述了美国 13 至 49 岁孕妇中妊娠相关 TCM 住院的发生率。使用 Joinpoint 回归描述妊娠相关 TCM 住院的年平均百分比变化。使用调查逻辑回归来衡量妊娠相关 TCM 住院与产妇结局的相关性。在 19754535 例妊娠相关住院中,有 590 例与 TCM 相关。在研究期间,妊娠相关 TCM 住院的总体趋势保持稳定。大多数 TCM 发生在产后,其次是产前和分娩相关的住院。与无 TCM 的妊娠住院相比,有 TCM 的患者更有可能年龄在 35 岁以上,并使用烟草和阿片类药物。TCM 相关妊娠住院的合并症包括心力衰竭、冠状动脉疾病、出血性中风和高血压。在控制潜在混杂因素后,与 TCM 相关的妊娠住院的 TCM 发生几率是 98.7 倍(调整后的优势比[aOR]=98.66,95%置信区间[CI]31.23-311.64)和 14.7 倍(aOR=14.75,95%CI 9.99-21.76)更高,分别经历住院期间死亡率和延长住院时间。尽管罕见,但妊娠相关 TCM 住院更可能发生在产后,并且与住院期间死亡率和延长住院时间相关。尽管罕见,但妊娠相关心尖球囊样综合征住院更可能发生在产后,并且与住院期间死亡率和延长住院时间相关。

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