Faucher Loïc, Matsushita Kensuke, Kikuchi Shinnosuke, Tatarcheh Taraneh, Marchandot Benjamin, Granier Amandine, Amissi Said, Trimaille Antonin, Jesel Laurence, Ohlmann Patrick, Hibi Kiyoshi, Schini-Kerth Valérie, Morel Olivier
Université de Strasbourg, Pôle d'Activité Médico-Chirurgicale Cardio-Vasculaire, Nouvel Hôpital Civil, Centre Hospitalier Universitaire, Strasbourg, France.
Translational Cardiovascular Medicine, CRBS, University of Strasbourg, Strasbourg, France.
ESC Heart Fail. 2025 Apr;12(2):1427-1436. doi: 10.1002/ehf2.15161. Epub 2025 Jan 16.
Initially described as a benign acute cardiomyopathy, Takotsubo syndrome has been linked to elevated mortality rates. Emerging evidence suggests that unresolved myocardial inflammation may contribute to this adverse prognosis. This study aimed to evaluate the incremental prognostic utility of C-reactive protein (CRP) in conjunction with the InterTAK prognosis score for stratifying long-term mortality in Takotsubo syndrome.
A retrospective analysis was conducted from a multicentre registry encompassing 307 patients diagnosed with Takotsubo syndrome between 2008 and 2020. Patients were stratified into quartiles based on the InterTAK prognosis score. The discriminatory potential of CRP in predicting long-term mortality was assessed. The primary endpoint was defined as all-cause mortality within 1 year.
A stepwise increase of CRP at discharge that corresponds to INTERTAK quartiles was observed: 9.5 mg/L (25th percentile) in the first quartile, 15.8 mg/L (median) in the second quartile, 25.3 mg/L (75th percentile) in the third quartile and 41.2 mg/L (maximum) in the fourth quartile. Receiver operating-characteristic curves analysis revealed that CRP value at discharge was predictive of 1 year mortality (area under the curve = 0.81; 95% confidence interval = 0.68-0.90) with an optimal threshold set at 33 mg/L (sensitivity: 65%; specificity: 87%). When considering the InterTAK score, the incorporation of CRP at discharge with a cut-off of 33 mg/L exhibited a significant enhancement in the prediction of 1 year mortality in 'intermediate' risk (25% vs. 1%; P = 0.008) or 'very high' risk (40% vs. 10%; P = 0.02) patients.
In Takotsubo syndrome, the persistence of inflammatory burden at hospital discharge emerged as an independent predictor of 1 year mortality, augmenting the predictive capacity of the conventional InterTAK prognosis score.
应激性心肌病最初被描述为一种良性急性心肌病，但其与死亡率升高有关。新出现的证据表明，未解决的心肌炎症可能导致这种不良预后。本研究旨在评估C反应蛋白（CRP）联合InterTAK预后评分对应激性心肌病长期死亡率分层的增量预后效用。
对一个多中心登记处进行回顾性分析，该登记处纳入了2008年至2020年间诊断为应激性心肌病的307例患者。根据InterTAK预后评分将患者分为四分位数。评估CRP预测长期死亡率的辨别潜力。主要终点定义为1年内的全因死亡率。
观察到出院时CRP随INTERTAK四分位数呈逐步升高：第一四分位数为9.5mg/L（第25百分位数），第二四分位数为15.8mg/L（中位数），第三四分位数为25.3mg/L（第75百分位数），第四四分位数为41.2mg/L（最大值）。受试者工作特征曲线分析显示，出院时的CRP值可预测1年死亡率（曲线下面积=0.81；95%置信区间=0.68-0.90），最佳阈值设定为33mg/L（敏感性：65%；特异性：87%）。当考虑InterTAK评分时，出院时CRP截断值为33mg/L，在预测“中度”风险（25%对1%；P=0.008）或“极高”风险（40%对10%；P=0.02）患者的1年死亡率方面有显著增强。
在应激性心肌病中，出院时炎症负担的持续存在是1年死亡率的独立预测因素，增强了传统InterTAK预后评分的预测能力。
