Abstract：
Takotsubo syndrome (TTS) with physical triggers has worse short- and long-term clinical courses than those with emotional triggers. However, predictive factors associated with poor outcomes of TTS with physical triggers are unknown.
We included 231 patients identified as TTS preceded by physical triggers at two tertiary referral hospitals from 2010 to 2019. In-hospital complications (IHC)-a composite of malignant arrhythmia, need for mechanical circulatory support or mechanical ventilation, and in-hospital death-and overall mortality were retrospectively reviewed. The associations with clinical features were evaluated by multivariable logistic and Cox regression analyses.
The mean age was 69.3 ± 11.6 years, and 85 (36.8%) were male. The in-hospital complications rate was 46.8%. During a median follow-up of 883 days, 96 (41.6%) had died, and overall mortality was 13.6% per patient-year. Higher neutrophil-to-lymphocyte ratio (NLR) was associated with a higher risk of IHC (area under the receiver operating characteristic curve = 0.73; positive and negative predictive value = 60.9% and 67.2% for NLR ≤ 12); odds ratio (OR) with 95% confidence interval (CI) was 1.03 (1.01-1.05), p = 0.010. Subsequently, higher NLR was also related to a greater risk of overall mortality; patients with high NLR (NLR > 12) exhibited poor long-term survival than those with low NLR (NLR ≤ 5): hazard ratio (95% CI), 3.70 (1.72-7.94) with p < 0.001.
A high NLR at initial presentation is associated with an increased risk of IHC and overall mortality in TTS preceded by physical triggers. Given that the treatment of TTS is mainly supportive, intensive monitoring with careful follow-up would be warranted in patients with high NLR.
We included 231 patients identified as TTS preceded by physical triggers at two tertiary referral hospitals from 2010 to 2019. In-hospital complications (IHC)-a composite of malignant arrhythmia, need for mechanical circulatory support or mechanical ventilation, and in-hospital death-and overall mortality were retrospectively reviewed. The associations with clinical features were evaluated by multivariable logistic and Cox regression analyses.
The mean age was 69.3 ± 11.6 years, and 85 (36.8%) were male. The in-hospital complications rate was 46.8%. During a median follow-up of 883 days, 96 (41.6%) had died, and overall mortality was 13.6% per patient-year. Higher neutrophil-to-lymphocyte ratio (NLR) was associated with a higher risk of IHC (area under the receiver operating characteristic curve = 0.73; positive and negative predictive value = 60.9% and 67.2% for NLR ≤ 12); odds ratio (OR) with 95% confidence interval (CI) was 1.03 (1.01-1.05), p = 0.010. Subsequently, higher NLR was also related to a greater risk of overall mortality; patients with high NLR (NLR > 12) exhibited poor long-term survival than those with low NLR (NLR ≤ 5): hazard ratio (95% CI), 3.70 (1.72-7.94) with p < 0.001.
A high NLR at initial presentation is associated with an increased risk of IHC and overall mortality in TTS preceded by physical triggers. Given that the treatment of TTS is mainly supportive, intensive monitoring with careful follow-up would be warranted in patients with high NLR.
摘要：
背景：具有身体触发因素的Takotsubo综合征（TTS）的短期和长期临床病程比具有情绪触发因素的患者更差。然而,与具有身体触发因素的TTS不良结局相关的预测因素未知.
方法：我们纳入了2010年至2019年在两家三级转诊医院确定为TTS之前有身体诱因的231例患者。院内并发症（IHC）-恶性心律失常的复合，需要机械循环支持或机械通气，对院内死亡和总死亡率进行回顾性分析.通过多变量logistic和Cox回归分析评估与临床特征的关联。
结果：平均年龄为69.3±11.6岁，男性85人(36.8%)。院内并发症发生率为46.8%。在883天的中位随访中，96人(41.6%)死亡，总死亡率为每患者年13.6%.较高的中性粒细胞与淋巴细胞比率（NLR）与较高的IHC风险相关（受试者工作特征曲线下面积=0.73；NLR≤12的阳性和阴性预测值=60.9％和67.2％）；95％置信区间（CI）的比值比（OR）为1.03（1.01-1.05），p=0.010。随后，较高的NLR也与较高的总死亡率相关;高NLR(NLR>12)患者的长期生存率低于低NLR(NLR≤5):风险比(95%CI),3.70（1.72-7.94），p<0.001。
结论：初次就诊时的高NLR与IHC风险增加和TTS的总死亡率增加相关，然后是物理触发因素。鉴于TTS的治疗主要是支持性的，对于NLR较高的患者,需要加强监测和仔细随访.
方法：我们纳入了2010年至2019年在两家三级转诊医院确定为TTS之前有身体诱因的231例患者。院内并发症（IHC）-恶性心律失常的复合，需要机械循环支持或机械通气，对院内死亡和总死亡率进行回顾性分析.通过多变量logistic和Cox回归分析评估与临床特征的关联。
结果：平均年龄为69.3±11.6岁，男性85人(36.8%)。院内并发症发生率为46.8%。在883天的中位随访中，96人(41.6%)死亡，总死亡率为每患者年13.6%.较高的中性粒细胞与淋巴细胞比率（NLR）与较高的IHC风险相关（受试者工作特征曲线下面积=0.73；NLR≤12的阳性和阴性预测值=60.9％和67.2％）；95％置信区间（CI）的比值比（OR）为1.03（1.01-1.05），p=0.010。随后，较高的NLR也与较高的总死亡率相关;高NLR(NLR>12)患者的长期生存率低于低NLR(NLR≤5):风险比(95%CI),3.70（1.72-7.94），p<0.001。
结论：初次就诊时的高NLR与IHC风险增加和TTS的总死亡率增加相关，然后是物理触发因素。鉴于TTS的治疗主要是支持性的，对于NLR较高的患者,需要加强监测和仔细随访.
