Takotsubo综合征女性与前壁ST段抬高型心肌梗死女性心肌功能随时间变化的前瞻性比较。
Prospective comparison of temporal changes in myocardial function in women with Takotsubo versus anterior STEMI.
作者信息
Jha Sandeep, Poller Angela, Shekka Espinosa Aaron, Molander Linnea, Sevastianova Valentyna, Zeijlon Rickard, Simons Koen, Bobbio Emanuele, Pirazzi Carlo, Martinsson Andreas, Mellberg Tomas, Gudmundsson Thorsteinn, Torild Petronella, Sundstrom Joakim, Andersson Erik Axel, Thorleifsson Sigurdur, Salahuddin Sabin, Elmahdy Ahmed, Pylova Tetiana, Rawshani Araz, Angeras Oskar, Ramunddal Truls, Skoglund Kristofer, Omerovic Elmir, Redfors Bjorn
机构信息
Department of Molecular and Clinical Medicine, Institute of Medicine, University of Gothenburg, Gothenburg, Sweden.
Department of Cardiology, Sahlgrenska University Hospital/S, Bruna Straket 16, 431 45, Gothenburg, Sweden.
出版信息
Clin Res Cardiol. 2025 Mar 20. doi: 10.1007/s00392-025-02633-4.
BACKGROUND
Takotsubo syndrome (TS) and STEMI with timely reperfusion are both characterized by reversible acute myocardial dysfunction, often referred to as myocardial stunning. The natural course of cardiac functional recovery is incompletely understood in TS and STEMI. The aim of this study was to prospectively compare changes in cardiac function over the acute and subacute phases in women with TS versus anterior STEMI.
METHODS
The Stunning in Takotsubo versus Acute Myocardial Infarction (STAMI) study prospectively enrolled 61 women with TS and 41 women with STEMI. Echocardiography and blood sampling was performed within 4 h of admission and at 1, 2, 3, 7, 14, and 30 days after admission. The primary outcome was the proportion of reversible left ventricular akinesia (defined as extent of akinesia at baseline versus at 30 days) that resolved by 72 h. Secondary outcomes included LVEF, GLS, and TAPSE. Mixed effects linear regression or mixed effects tobit models with random intercepts were used to model echocardiographic parameters over time.
RESULTS
At 72 h 40.4% [95% CI 30.1%, 50.1%] of the reversible akinesia had resolved in women with TS, versus 54.7% [95% CI 38.3%, 72.0%] for STEMI (difference 14.3% [95% CI - 4.6%, 34.3%]). Time-course of recovery of LVEF and GLS was also similar in TS and STEMI. TAPSE was reduced in TS but normal in STEMI; and recovered in a similar timeframe as the left ventricular indices. In both TS and STEMI, considerable recovery of cardiac function occurred after 7 days.
CONCLUSIONS
The time course of recovery of cardiac function is similar in TS and STEMI.
TRIAL REGISTRATION
ClinicalTrials.gov ID NCT04448639, https://clinicaltrials.gov/study/NCT04448639 .
背景
应激性心肌病（TS）和及时再灌注治疗的ST段抬高型心肌梗死（STEMI）均以可逆性急性心肌功能障碍为特征，常被称为心肌顿抑。目前对TS和STEMI中心脏功能恢复的自然病程尚未完全了解。本研究的目的是前瞻性比较TS女性与前壁STEMI女性在急性期和亚急性期心脏功能的变化。
方法
应激性心肌病与急性心肌梗死中的心肌顿抑（STAMI）研究前瞻性纳入了61例TS女性和41例STEMI女性。在入院后4小时内以及入院后1、2、3、7、14和30天进行超声心动图检查和血液采样。主要结局是在72小时内恢复的可逆性左心室运动减退比例（定义为基线时与30天时运动减退的程度）。次要结局包括左心室射血分数（LVEF）、整体纵向应变（GLS）和三尖瓣环平面收缩期位移（TAPSE）。使用具有随机截距的混合效应线性回归或混合效应 Tobit 模型对随时间变化的超声心动图参数进行建模。
结果
在72小时时，TS女性中40.4%[95%置信区间30.1%，50.1%]的可逆性运动减退已恢复，而STEMI女性为54.7%[95%置信区间38.3%，72.0%]（差异14.3%[95%置信区间 - 4.6%，34.3%]）。TS和STEMI中LVEF和GLS的恢复时间进程也相似。TS中TAPSE降低，而STEMI中正常；并且在与左心室指标相似的时间范围内恢复。在TS和STEMI中，7天后心脏功能均有显著恢复。
结论
TS和STEMI中心脏功能恢复的时间进程相似。
试验注册
ClinicalTrials.gov标识符NCT04448639，https://clinicaltrials.gov/study/NCT04448639 。
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