Department of Clinical Epidemiology and Health Economics, School of Public Health, The University of Tokyo, Tokyo, Japan.
Department of Cardiology, Tokyo Metropolitan Tama Medical Center, Tokyo, Japan.
Cardiology. 2024;149(4):314-324. doi: 10.1159/000537971. Epub 2024 Feb 22.
Takotsubo syndrome (TTS) is a cardiac disorder that mimics acute coronary syndrome at presentation. While previous studies have demonstrated a relationship between body mass index (BMI) and outcomes in acute coronary syndrome, few have examined its relationship with TTS.
Using the Japanese Diagnosis Procedure Combination database, we retrospectively identified 14,551 patients admitted for TTS between 2010 and 2021. By applying multivariable regressions with restricted cubic splines, we examined the association between BMI and in-hospital mortality after adjusting for potential confounders.
Mean BMI was 21.1 kg/m2, classifying patients into severe underweight (<16.0 kg/m2, 7.1%), mild/moderate underweight (16.0-18.4 kg/m2, 18.3%), normal weight (18.5-22.9 kg/m2, 46.8%), overweight (23.0-27.4 kg/m2, 22.2%), and obese (≥27.5 kg/m2, 5.6%) groups. Patients with severe or mild/moderate underweight were older and had a higher prevalence of impaired physical activity, malignancy, chronic pulmonary disease, and pneumonia. In-hospital mortality was the highest (9.4%) in the severe underweight group, followed by the mild/moderate underweight group (5.4%), with the lowest being in the obese group (2.1%). Severe underweight (adjusted odds ratio = 2.05; 95% confidence interval [CI] = 1.54-2.73) and mild/moderate underweight (1.26; 95% CI = 1.01-1.57) were significantly associated with higher mortality compared with normal weight, while no significant association was noted with obesity. A nonlinear association between continuous BMI and mortality was observed, with mortality increasing when BMI decreased <20.0 kg/m2 but nearly plateauing in BMI >20.0 kg/m2.
The present nationwide analysis demonstrated a nonlinear association between BMI and in-hospital mortality of TTS. BMI is an easily available and clinically relevant marker for the risk stratification of TTS.
Takotsubo 综合征（TTS）是一种在发病时类似于急性冠状动脉综合征的心脏疾病。虽然先前的研究已经证明了体重指数（BMI）与急性冠状动脉综合征的结果之间存在关系，但很少有研究检查其与 TTS 的关系。
使用日本诊断程序组合数据库，我们回顾性地确定了 2010 年至 2021 年间因 TTS 住院的 14551 名患者。通过应用带有限制立方样条的多变量回归，我们在调整潜在混杂因素后，检查了 BMI 与住院死亡率之间的关联。
平均 BMI 为 21.1kg/m2，将患者分为严重消瘦（<16.0kg/m2，7.1%）、轻度/中度消瘦（16.0-18.4kg/m2，18.3%）、正常体重（18.5-22.9kg/m2，46.8%）、超重（23.0-27.4kg/m2，22.2%）和肥胖（≥27.5kg/m2，5.6%）组。严重消瘦或轻度/中度消瘦的患者年龄较大，身体活动能力受损、恶性肿瘤、慢性肺病和肺炎的患病率较高。住院死亡率最高（9.4%）是严重消瘦组，其次是轻度/中度消瘦组（5.4%），最低的是肥胖组（2.1%）。与正常体重相比，严重消瘦（调整后的优势比=2.05；95%置信区间[CI] = 1.54-2.73）和轻度/中度消瘦（1.26；95%CI = 1.01-1.57）与更高的死亡率显著相关，而肥胖与死亡率无显著相关性。连续 BMI 与死亡率之间存在非线性关联，当 BMI 降低 <20.0kg/m2 时死亡率增加，但 BMI >20.0kg/m2 时几乎趋于平稳。
本项全国性分析表明，BMI 与 TTS 住院死亡率之间存在非线性关联。BMI 是 TTS 风险分层的一个易于获得且具有临床意义的标志物。
