Vemmou Evangelia, Basala Thomas, Witt Dawn, Nikolakopoulos Ilias, Bergstedt Seth, Xenogiannis Iosif, Brilakis Emmanouil S, Hauser Robert G, Sharkey Scott W
Department of Internal Medine, Yale New Haven Hospital, New Haven, Connecticut, USA.
Minneapolis Heart Institute Foundation, Minneapolis, Minnesota, USA.
JACC Adv. 2024 Sep 6;3(10):101263. doi: 10.1016/j.jacadv.2024.101263. eCollection 2024 Oct.
During takotsubo syndrome (TS), QTc prolongation is common, reflecting repolarization injury and providing the substrate for torsades de pointes (TdP). TdP has been reported sporadically in TS, yet QTc prolongation and TdP risk are often overlooked during management.
In TS patients, we sought to document TdP incidence, characteristics of patients with TdP, and association of QTc with postdischarge survival.
Among consecutive TS patients at a single institution, we documented admission and discharge QTc, TdP incidence, and postdischarge 1-year mortality from 2006 to 2019. For perspective regarding TdP-TS risk, we characterized all published TdP cases from 2003 to 2022.
Of 259 patients, median age was 68 (range: 59-77) years; 92% were female. The QTc interval was prolonged (≥460 ms) on admission in 129 (49.8%) patients and at discharge in 140 (54%) patients. QTc was ≥500 ms either on admission or at discharge in 98 (37.8%) patients. In-hospital TdP incidence was 0.8%. Postdischarge mortality was associated with admission but not discharge, QTc: <460 ms (1.6%); 460-499 ms (12.6%); ≥500 ms (8.8%); = 0.0056. Among 38 published TdP-TS cases, 80% of TdP events were within 48 hours of hospitalization, 90% of events occurred with QTc ≥500 ms, and 47.5% of events occurred with QTc ≥600 ms. Conditions associated with TdP risk were present in fewer than one-third of patients.
During TS, QTc ≥500 ms was frequent. TdP incidence was low, with unpredictable occurrence and observed almost entirely with QTc ≥500 ms. A normal admission QTc was associated with >98% survival at 1-year postdischarge.
在应激性心肌病（TS）期间，QTc延长很常见，反映了复极损伤并为尖端扭转型室速（TdP）提供了基质。TdP在TS中偶有报道，但在治疗过程中QTc延长和TdP风险常常被忽视。
在TS患者中，我们试图记录TdP的发生率、TdP患者的特征以及QTc与出院后生存率的关联。
在一家机构的连续TS患者中，我们记录了2006年至2019年的入院和出院时的QTc、TdP发生率以及出院后1年的死亡率。为了解TdP-TS风险的情况，我们对2003年至2022年所有已发表的TdP病例进行了特征分析。
259例患者中，中位年龄为68岁（范围：59 - 77岁）；92%为女性。129例（49.8%）患者入院时QTc间期延长（≥460毫秒），140例（54%）患者出院时QTc间期延长。98例（37.8%）患者入院或出院时QTc≥500毫秒。院内TdP发生率为0.8%。出院后死亡率与入院时而非出院时的QTc相关：<460毫秒（1.6%）；460 - 499毫秒（12.6%）；≥500毫秒（8.8%）；P = 0.0056。在38例已发表的TdP-TS病例中，80%的TdP事件发生在住院48小时内，90%的事件发生时QTc≥500毫秒，47.5%的事件发生时QTc≥600毫秒。不到三分之一的患者存在与TdP风险相关的情况。
在TS期间，QTc≥500毫秒很常见。TdP发生率低，发生不可预测，且几乎全部发生在QTc≥500毫秒时。入院时QTc正常与出院后1年生存率>98%相关。
