应激性心肌病临床特点及预后分析

Clinical Features and Outcomes of Patients With Takotsubo Cardiomyopathy

目的:分析应激性心肌病患者临床资料,总结临床特点及远期预后情况。方法:收集2011-01至2017-12在我院住院确诊为应激性心肌病患者,收集临床资料,定期门诊及电话随访,记录预后情况。结果:共计15例患者入组,其中女性13例(86.7%),入院时超声心动图提示节段性室壁运动异常伴心尖部室壁瘤形成,左心室射血分数为(44.80±10.70)%,血清N末端B型利钠肽原(NT-pro BNP)水平为(2 429.10±2 283.43)pg/ml,经积极治疗出院时超声心动图复查提示节段性室壁运动异常及室壁瘤消失,左心室射血分数提高至(62.90±7.60)%,血清NT-pro BNP水平降至(715.14±1 912.31)pg/ml,自身前后比较差异有统计学意义(P=0.001),随访过程中无死亡事件,1例首诊2年后争吵复发再住院,治疗后恢复。结论:应激性心肌病患者常有超声心动图节段性室壁运动异常及室壁瘤样改变,伴有NT-pro BNP明显增高,积极对症治疗后超声复查节段性室壁运动异常可消失,心功能可恢复,NT-pro BNP可明显下降,整体预后好,但仍需注意出院宣教,警惕复发。

Objectives：We aimed to elucidate the clinical characteristics and outcomes of patients with Takotsubo cardiomyopathy who were hospitalized in Fuwai Hospital.Methods： This study included a total of 15 consecutive patients with Takotsubo cardiomyopathy, who were hospitalized in our hospital between January 2011 and December 2017.Results： The study population included 2 men（13.3%） and 13 women（86.7%）（Median age： 66 years）. Physical stress and emotional stress were identified as triggers in 5（33.3%） patients and 10（76.7%） patients, respectively. Echocardiographic changes（wall motion abnormalities including apical akinesia） were observed in all patients. Post therapy, left ventricular ejection fraction（LVEF） was significantly increased from（44.80±10.70）% to（62.90±7.60）%,and the serum level of NTpro BNP was decreased from（2 429.10±2 283.43） pg/ml to（715.14±1 912.31）pg/ml as compared to the baseline levels（both P=0.001）. There was no death during follow up and Takotsubo cardiomyopathy reoccurred in one patient during follow-up after repeat emotional stress and the patient was recovered after therapy. Conclusions： Takotsubo cardiomyopathy is associated with transient wall motion abnormalities, typically presented as apical akinesia, and increased NT-pro BNP values. Wall motion abnormalities could be recovered and NT-pro BNP values could be reduced post therapy, prognosis is good for patients with Takotsubo cardiomyopathy and stressors should be avoided to reduce the possibility of disease reoccurrence.