Takotsubo综合征患者住院死亡危险因素

Risk Factors for in-Hospital Mortality in Patients with Takotsubo Syndrome

【目的】探讨Takotsubo综合征(TTS)患者住院死亡的危险因素。【方法】回顾性分析我院2009年2月至2022年1月诊断为TTS患者的住院资料,根据住院期间是否死亡分为死亡组和存活组,比较两组患者的一般临床资料、诱发因素、实验室检查、心电图、超声心动图、并发症和治疗措施,采用单因素logistic回归分析筛选TTS患者住院死亡可能的危险因素,多因素logistic回归分析确定TTS患者住院死亡的危险因素。【结果】本研究共纳入TTS患者62例,其中男21例(33.9%),女41例(66.1%),绝经后女性26例(41.9%),年龄(55.6±16.2)岁,躯体应激50例(80.6%)。住院期间死亡17例(27.4%),存活45例(72.6%)。TTS死亡组收缩压、左室射血分数(LVEF)较存活组低,其发生晕厥比例、氨基末端B型利钠肽前体(NT-proBNP)及高敏肌钙蛋白T(hs TnT)水平均较存活组高(P值均<0.05);诱发因素中,死亡组由于神经系统疾病所诱发TTS的比例高于存活组(P<0.05);死亡组发生心原性休克、恶性室性心律失常、心房颤动、呼吸衰竭及治疗用多巴胺、治疗用去甲肾上腺素、血液透析及机械通气的比例均较存活组高(P值均<0.05)。单因素logistic回归分析显示,晕厥、NT-proBNP、LVEF、神经系统疾病、心原性休克、恶性室性心律失常、心房颤动、呼吸衰竭、治疗用多巴胺、治疗用去甲肾上腺素、血液透析及机械通气是TTS患者住院死亡的可能危险因素(P值均<0.05)。多因素logistic回归分析显示,神经系统疾病[OR(95%CI)=5.651(1.195,26.715),P=0.029]、心房颤动[OR(95%CI)=6.217(1.276,30.298),P=0.024]、治疗用去甲肾上腺素[OR(95%CI)=8.847(1.912,40.949),P=0.005]是TTS患者住院死亡的独立危险因素。【结论】神经系统疾病、心房颤动、治疗用去甲肾上腺素是TTS患者住院死亡的独立危险因素,临床上需注意神经系统疾病、心房颤动的防治,对于已确诊TTS合并血流动力学不稳定患者需慎重使用去甲肾上腺素。

【Objective】 To analyze the risk factors for in-hospital mortality in patients with Takotsubo Syndrome(TTS).【Methods】 Hospitalization data of consecutive patients with TTS from February 2009 to January 2022 were retrospectively collected and analyzed. Patients were divided into survival group and death group according to outcomes. The basic clinical information, triggering factors, laboratory examinations, electrocardiogram, echocardiography, complications and treatments of the two groups were compared. Univariable logistic regression analysis was used to screen the possible risk factors for in-hospital mortality in TTS patients, and multivariable logistic regression analysis was used to determine the independent risk factors for in-hospital mortality in TTS patients.【Results】A total of 62 TTS patients were included in our study, including 21 males(33.9%), 41 females(66.1%) and 26 postmenopausal women(41.9%), with the mean age of(55.6±16.2) years, and physical triggers were found in 50 patients(80.6%). 17 patients(27.4%) died while 45 patients(72.6%) survived during hospitalization. The death group had lower systolic blood pressure and left ventricular ejection fraction(LVEF), higher incidence rate of syncope, higher level of N-terminal pro-B natriuretic peptide(NTproBNP) and hypersensitive troponin T(hs TnT) when compared with survival group(all P value <0.05). As for the triggering factors, the proportion of TTS induced by neurologic disorders in the death group was higher than that in the survival group(P<0.05). The death group had higher rates of cardiogenic shock, malignant ventricular arrhythmia, atrial fibrillation, and respiratory failure(all P value <0.05). Compared with the survival group, therapeutic dopamine, therapeutic norepinephrine, hemodialysis and mechanical ventilation were higher in the death group(all P value <0.05). Univariable logistic regression analysis suggested that syncope, NT-proBNP, LVEF, neurologic disorders, cardiogenic shock, malignant ventricular arrhythmia, atrial fibrillation, respiratory failure, therapeutic dopamine, therapeutic norepinephrine, hemodialysis and mechanical ventilation were potential risk factors for in-hospital mortality in TTS patients(all P value <0.05). Multivariable logistic regression analysis indicated that neurologic disorders [OR(95%CI)=5.651(1.195,26.715),P=0.029], atrial fibrillation [OR(95%CI)=6.217(1.276,30.298), P=0.024] and therapeutic norepinephrin [OR(95%CI)=8.847(1.912,40.949), P=0.005] were independent risk factors for in-hospital mortality in TTS patients.【Conclusions】Neurologic disorders, atrial fibrillation and therapeutic norepinephrin are independent risk factors for in-hospital mortality in patients with Takotsubo Syndrome. Clinically, attention should be paid to the prevention and treatment of neurologic disorders and atrial fibrillation;norepinephrine should be carefully used in patients with diagnosed TTS complicated with hemodynamic instability.