PDF(Pubmed)
Abstract：
BACKGROUND: Takotsubo syndrome is, by definition, a reversible form of acute heart failure. If cardiac output is severely reduced, Takotsubo syndrome can cause cardiogenic shock, and mechanical circulatory support can serve as a bridge to recovery. To date, there are no recommendations on when to use mechanical circulatory support and on which device is particularly effective in this context. Our aim was to determine the best treatment strategy.
METHODS: A systematic literature research and analysis of individual patient data was performed in MEDLINE/PubMed according to PRISMA guidelines. Our research considered original works published until 31 July 2023.
RESULTS: A total of 93 publications that met the inclusion criteria were identified, providing individual data from 124 patients. Of these, 62 (50%) were treated with veno-arterial extracorporeal life support (va-ECLS), and 44 (35.5%) received a microaxial left ventricular assist device (Impella). Eighteen patients received an Impella CP and twenty-one an Impella 2.5. An intra-aortic balloon pump (IABP) without other devices was used in only 13 patients (10.5%), while other devices (BiVAD or Tandem Heart) were used in 5 patients (4%). The median initial left ventricular ejection fraction was 20%, with no difference between the four device groups except for the IABP group, which was less affected by cardiac output failure (p = 0.015). The overall survival was 86.3%. Compared to the other groups, the time to cardiac recovery was shorter with Impella (p < 0.001).
CONCLUSIONS: Though the Impella treatment is new, our analysis may show a significant benefit of Impella compared to other MCS strategies for cardiogenic shock in Takotsubo syndrome.
METHODS: A systematic literature research and analysis of individual patient data was performed in MEDLINE/PubMed according to PRISMA guidelines. Our research considered original works published until 31 July 2023.
RESULTS: A total of 93 publications that met the inclusion criteria were identified, providing individual data from 124 patients. Of these, 62 (50%) were treated with veno-arterial extracorporeal life support (va-ECLS), and 44 (35.5%) received a microaxial left ventricular assist device (Impella). Eighteen patients received an Impella CP and twenty-one an Impella 2.5. An intra-aortic balloon pump (IABP) without other devices was used in only 13 patients (10.5%), while other devices (BiVAD or Tandem Heart) were used in 5 patients (4%). The median initial left ventricular ejection fraction was 20%, with no difference between the four device groups except for the IABP group, which was less affected by cardiac output failure (p = 0.015). The overall survival was 86.3%. Compared to the other groups, the time to cardiac recovery was shorter with Impella (p < 0.001).
CONCLUSIONS: Though the Impella treatment is new, our analysis may show a significant benefit of Impella compared to other MCS strategies for cardiogenic shock in Takotsubo syndrome.
摘要：
背景：Takotsubo综合征是，根据定义,一种可逆形式的急性心力衰竭。如果心输出量严重减少,Takotsubo综合征可引起心源性休克,机械循环支持可以作为恢复的桥梁。迄今为止,没有关于何时使用机械循环支持以及在这种情况下哪种设备特别有效的建议。我们的目标是确定最佳治疗策略。
方法：根据PRISMA指南，在MEDLINE/PubMed中对个体患者数据进行了系统文献研究和分析。我们的研究考虑了直到2023年7月31日发表的原创作品。
结果：共确定了93份符合纳入标准的出版物，提供来自124名患者的个人数据。其中,62（50％）接受了静脉动脉体外生命支持（va-ECLS）治疗，和44（35.5％）接受了微轴左心室辅助装置（Impella）。18例患者接受了ImpellaCP，21例接受了Impella2.5。仅13例患者（10.5％）使用了无其他装置的主动脉内球囊泵（IABP），而其他设备（BiVAD或串联心脏）在5例患者中使用（4％）。初始左心室射血分数中位数为20%，除IABP组外，四个设备组之间没有差异，受心输出量衰竭的影响较小（p=0.015）。总生存率为86.3%。与其他组相比，Impella组的心脏恢复时间较短(p<0.001).
结论：虽然Impella治疗是新的，我们的分析可能表明,与其他MCS策略相比,Impella对Takotsubo综合征的心源性休克具有显著的益处.
方法：根据PRISMA指南，在MEDLINE/PubMed中对个体患者数据进行了系统文献研究和分析。我们的研究考虑了直到2023年7月31日发表的原创作品。
结果：共确定了93份符合纳入标准的出版物，提供来自124名患者的个人数据。其中,62（50％）接受了静脉动脉体外生命支持（va-ECLS）治疗，和44（35.5％）接受了微轴左心室辅助装置（Impella）。18例患者接受了ImpellaCP，21例接受了Impella2.5。仅13例患者（10.5％）使用了无其他装置的主动脉内球囊泵（IABP），而其他设备（BiVAD或串联心脏）在5例患者中使用（4％）。初始左心室射血分数中位数为20%，除IABP组外，四个设备组之间没有差异，受心输出量衰竭的影响较小（p=0.015）。总生存率为86.3%。与其他组相比，Impella组的心脏恢复时间较短(p<0.001).
结论：虽然Impella治疗是新的，我们的分析可能表明,与其他MCS策略相比,Impella对Takotsubo综合征的心源性休克具有显著的益处.
