摘要
目的总结中国Takotsubo综合征(TTS)患者的临床特征,并识别影响心律失常发生的危险因素。方法本研究为多中心病例对照研究。纳入2010年6月至2022年12年武汉大学人民医院、浙江大学丽水医院和浙江大学医学院附属第二医院的TTS患者,收集患者的临床特征,实验室检查、心电图和心脏影像学检查结果;排除既往有心律失常病史的患者后,比较心律失常组和非心律失常组临床资料差异,并采用单因素和多因素Logistic回归评估心律失常的相关因素。结果纳入263例TTS患者,年龄(59.6±18.7)岁,其中男占30.8%(81/263)。55.5%(117/263)患者由生理因素触发;心尖型为主要的TTS类型(81.4%,214/263);ST段抬高(29.3%,77/263)和早复极模式(22.1%,58/263)是较常见的心电图表现。院内主要不良心血管事件发生率为38.4%(101/263);心律失常总发生率为38.8%(102/263),其中房性心律失常发生率为31.6%(83/263),室性心律失常为11.0%(29/263),传导障碍为2.3%(6/263)。多因素Logistic回归显示,年龄<55岁或>74岁(OR=2.62,95%CI 1.37~5.02,P=0.004)、心悸(OR=5.50,95%CI 1.99~15.15,P=0.001)、发热(OR=4.03,95%CI 1.11~14.71,P=0.035)、器质性心脏病史(OR=6.76,95%CI 1.93~23.81,P=0.003)、非经典TTS类型(OR=2.27,95%CI 1.03~5.00,P=0.041)及心电图校正的QT(QTc)间期延长(OR=2.84,95%CI 1.46~5.53,P=0.002)是TTS患者发生心律失常的独立危险因素。结论中国TTS患者以中老年为主,多由生理因素触发,且并发心律失常多见。年龄<55岁或>74岁、心悸、发热、器质性心脏病史、非经典TTS类型及QTc间期延长为住院期间心律失常发生的独立危险因素。
Objective To summarize the clinical features of Chinese patients with Takotsubo syndrome(TTS)and identify the risk factors affecting the occurrence of arrhythmias,providing scientific basis for clinical risk assessment and treatment decisions.Methods This study was a multi-center case-control study,including TTS patients hospitalized beween June 2010 and December 2022 from Renmin Hospital of Wuhan University,Lishui Hospital of Zhejiang University,and The Second Affiliated Hospital of Zhejiang University School of Medicine.Clinical features,laboratory tests,electrocardiograms,and cardiac imaging results were collected.After excluding patients with a history of arrhythmias,the clinical data of arrhythmia and non-arrhythmia groups were compared.Univariate and multivariate Logistic regression were used to evaluate the risk factors associated with arrhythmias.Results In this study,263 TTS patients were included,with an average age of(59.6±18.7)years,of which 30.8%(81/263)were male;55.5%(117/263)of patients were triggered by physiological factors;apical type was the predominant TTS type(81.4%,214/263);ST segment elevation(29.3%,77/263)and early repolarization pattern(22.1%,58/263)were the most common electrocardiographic findings.The overall incidence of major adverse cardiovascular events during hospitalization was 38.4%(101/263).The total incidence of arrhythmias was 38.8%(102/263),including 31.6%(83/263)for atrial arrhythmias,11.0%(29/263)for ventricular arrhy-thmias,and 2.3%(6/263)for conduction disorders.Multivariate Logistic regression showed that age<55 years or>74 years(OR=2.62,95%CI 1.37-5.02,P=0.004),palpitations(OR=5.50,95%CI 1.99-15.15,P=0.001),fever(OR=4.03,95%CI 1.11-14.71,P=0.035),a history of organic heart disease(OR=6.76,95%CI 1.93-23.81,P=0.003),non-classic TTS type(OR=2.27,95%CI 1.03-5.00,P=0.041),and prolonged corrected QT interval(OR=2.84,95%CI 1.46-5.53,P=0.002)were independent risk factors for arrhythmias in TTS patients.Conclusion Chinese patients with TTS are predominantly middle-aged or older,are most often precipitated by physical stressors,and are commonly complicated by arrhythmias.Age<55 or>74 years,palpitations,fever,a history of structural heart disease,non-classical TTS variants,and a prolonged QTc interval are independent risk factors for in-hospital arrhythmias.
作者
段弘毅
张中和
吕玲春
林小平
黄从新
胡丹
Duan Hongyi;Zhang Zhonghe;Lyu Lingchun;Lin Xiaoping;Huang Congxin;Hu Dan(Department of Cardiology,Renmin Hospital of Wuhan University,Cardiovascular Research Institute,Wuhan University,Hubei Key Laboratory of Cardiology,Wuhan 430060,China;Department of Cardiovascular,Lishui Hospital of Zhejiang University,Lishui 323000,China;Department of Cardiology,The Second Affiliated Hospital,Zhejiang University School of Medicine,Hangzhou 310009,China)
出处
《中华心律失常学杂志》
2025年第5期399-406,共8页
Chinese Journal of Cardiac Arrhythmias
基金
科技部国家重点研发计划(2023YFE0118300)
国家自然科学基金(82570386,82270332,81670304)
中央高校基本科研业务费-武汉大学自主研究项目(2042022kf1217)。
