嗜铬细胞瘤诱发的应激性心肌病的院内不良事件：172例病例的文献综述与聚类分析
In-Hospital Adverse Events of Pheochromocytoma-Induced Takotsubo Syndrome: A Literature Review and Cluster Analysis of 172 Cases.
作者信息
Xu Mei, Guan Qianglin, Liu Tianmin, Huang Yuxi, Pan Cunxue, Luo Liyun, Tang Wenyi, Xu Junwei, Huang Hsi, Xiao Li, Liu Kan, Chen Jian
机构信息
Department of Cardiovascular Medicine, The Fifth Affiliated Hospital of Sun Yat-sen University, 519000 Zhuhai, Guangdong, China.
Department of Radiology, The Fifth Affiliated Hospital of Sun Yat-sen University, 519000 Zhuhai, Guangdong, China.
出版信息
Rev Cardiovasc Med. 2024 Jun 14;25(6):216. doi: 10.31083/j.rcm2506216. eCollection 2024 Jun.
BACKGROUND
Pheochromocytoma-induced takotsubo syndrome (Pheo-TTS) significantly increases the risk of adverse events for inpatient. The early identification of risk factors at admission is crucial for effective risk stratification and minimizing complications in Pheo-TTS patients.
METHODS
We conducted a systematic review combined with hierarchical cluster and feature importance analysis of demographic, clinical and laboratory data upon admission, alongside in-hospital complication data for Pheo-TTS patients. We analyzed cases published in PubMed and Embase from 2 May 2006 to 27 April 2023.
RESULTS
Among 172 Pheo-TTS patients, cluster analysis identified two distinct groups: a chest pain dominant (CPD) group (n = 86) and a non-chest pain dominant (non-CPD) group (n = 86). The non-CPD group was characterized by a younger age (44.0 15.2 . 52.4 14.4, 0.001), a higher prevalence of neurological/psychiatric disorders (53.5% . 32.6%), and increased presentation of dyspnea (87.2% . 17.4%), pulmonary rales (59.3% . 8.1%), and tachycardia (77.9% . 30.2%). Additionally, they exhibited more atypical takotsubo syndrome (TTS) imaging phenotypes (55.8% . 36.5%, all 0.05). The non-CPD group experienced more than a 2-fold increase for in-hospital adverse events compared to the CPD group (70.9% . 30.2%, 0.001). After adjusting for confounding factors, the absence of chest pain (odds ratio [OR] = 0.407, 95% confidence interval [CI] 0.169-0.979, = 0.045), the presence of abdominal symptoms (OR = 3.939, 95% CI 1.770-8.766, = 0.001), pulmonary rales (OR = 4.348, 95% CI 1.857-10.179, = 0.001), and atypical TTS imaging phenotype (OR = 3.397, 95% CI 1.534-7.525, = 0.003) remained as independent predictors of in-hospital complications.
CONCLUSIONS
Clinical manifestations and imaging features at admission help to predict in-hospital complications for Pheo-TTS patients.
背景
嗜铬细胞瘤诱发的应激性心肌病（Pheo-TTS）显著增加了住院患者发生不良事件的风险。入院时早期识别风险因素对于Pheo-TTS患者进行有效的风险分层和减少并发症至关重要。
方法
我们对Pheo-TTS患者入院时的人口统计学、临床和实验室数据以及院内并发症数据进行了系统评价，并结合层次聚类和特征重要性分析。我们分析了2006年5月2日至2023年4月27日发表在PubMed和Embase上的病例。
结果
在172例Pheo-TTS患者中，聚类分析确定了两个不同的组：胸痛为主（CPD）组（n = 86）和非胸痛为主（非CPD）组（n = 86）。非CPD组的特征是年龄较小（44.0±15.2岁 vs. 52.4±14.4岁，P = 0.001），神经/精神疾病患病率较高（53.5% vs. 32.6%），呼吸困难（87.
2% vs. 17.4%）、肺部啰音（59.3% vs. 8.1%）和心动过速（77.9% vs. 30.2%）的表现增加。此外，他们表现出更多非典型应激性心肌病（TTS）影像学表型（55.8% vs. 36.5%，均P < 0.05）。与CPD组相比，非CPD组的院内不良事件增加了2倍多（70.9% vs. 30.2%，P = 0.001）。在调整混杂因素后，无胸痛（比值比[OR]=0.407，95%置信区间[CI]0.169 - 0.979，P = 0.045）、存在腹部症状（OR = 3.939，95%CI 1.770 - 8.766，P = 0.001）、肺部啰音（OR = 4.348，95%CI 1.857 - 10.179，P = 0.001）和非典型TTS影像学表型（OR = 3.397，95%CI 1.534 - 7.525，P = 0.003）仍然是院内并发症的独立预测因素。
结论
入院时的临床表现和影像学特征有助于预测Pheo-TTS患者的院内并发症。
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