PDF(Pubmed)
Abstract：
OBJECTIVE: Takotsubo syndrome (TTS) is a rare complication of vaccination. In this study, we sought to provide insight into the characteristics of reported TTS induced by vaccination.
RESULTS: We did a systematic review, searching PubMed, Embase, Web of Science, Ovid MEDLINE, Journals@Ovid, and Scopus databases up to 26 April 2023 to identify case reports or case series of vaccine-induced TTS. We then extracted and summarized the data from these reports. Eighteen reports were identified, with a total of 19 patients with TTS associated with vaccinations. Of the 19 included patients, the majority were female (n = 13, 68.4%) with a mean age of 56.6 ± 21.9 years. Seventeen patients developed TTS after coronavirus disease 2019 vaccination, 14 of whom received an mRNA vaccination. Two cases of TTS occurred after influenza vaccination. Among the 19 patients, 17 (89.5%) completed transthoracic echocardiography and 16 (84.2%) underwent angiography procedures. Seven patients (36.8%) completed cardiac magnetic resonance imaging. The median time to symptom onset was 2 (inter-quartile range, 1-4) days. The most common symptoms were chest pain (68.4%), dyspnoea (57.9%), and digestive symptoms (31.6%). A total of 57.9% of patients developed nonspecific symptoms such as fatigue, myalgia, diaphoresis, and fever. Among the 16 reported cases of TTS, 15 patients (93.8%) exhibited elevated cardiac troponin levels, while among the nine reported cases, eight patients (88.9%) had elevated natriuretic peptide levels. All patients had electrocardiographic changes: ST-segment change (47.1%), T-wave inversion (58.8%), and prolonged corrected QT interval (35.3%). The most common TTS type was apical ballooning (88.2%). Treatment during hospitalization typically included beta-blockers (44.4%), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (33.3%), and diuretics (22.2%). After treatment, 81.3% of patients were discharged with improved symptoms. Among this group, nine patients (56.3%) were reported to have recovered ventricular wall motion during follow-up. Two patients (12.5%) died following vaccination without resuscitation attempts.
CONCLUSIONS: TTS is a rare but potentially life-threatening complication of vaccination. Typical TTS symptoms such as chest pain and dyspnoea should be considered alarming symptoms, though nonspecific symptoms are common. The risks of such rare adverse events should be balanced against the risks of infection.
RESULTS: We did a systematic review, searching PubMed, Embase, Web of Science, Ovid MEDLINE, Journals@Ovid, and Scopus databases up to 26 April 2023 to identify case reports or case series of vaccine-induced TTS. We then extracted and summarized the data from these reports. Eighteen reports were identified, with a total of 19 patients with TTS associated with vaccinations. Of the 19 included patients, the majority were female (n = 13, 68.4%) with a mean age of 56.6 ± 21.9 years. Seventeen patients developed TTS after coronavirus disease 2019 vaccination, 14 of whom received an mRNA vaccination. Two cases of TTS occurred after influenza vaccination. Among the 19 patients, 17 (89.5%) completed transthoracic echocardiography and 16 (84.2%) underwent angiography procedures. Seven patients (36.8%) completed cardiac magnetic resonance imaging. The median time to symptom onset was 2 (inter-quartile range, 1-4) days. The most common symptoms were chest pain (68.4%), dyspnoea (57.9%), and digestive symptoms (31.6%). A total of 57.9% of patients developed nonspecific symptoms such as fatigue, myalgia, diaphoresis, and fever. Among the 16 reported cases of TTS, 15 patients (93.8%) exhibited elevated cardiac troponin levels, while among the nine reported cases, eight patients (88.9%) had elevated natriuretic peptide levels. All patients had electrocardiographic changes: ST-segment change (47.1%), T-wave inversion (58.8%), and prolonged corrected QT interval (35.3%). The most common TTS type was apical ballooning (88.2%). Treatment during hospitalization typically included beta-blockers (44.4%), angiotensin-converting enzyme inhibitors/angiotensin receptor blockers (33.3%), and diuretics (22.2%). After treatment, 81.3% of patients were discharged with improved symptoms. Among this group, nine patients (56.3%) were reported to have recovered ventricular wall motion during follow-up. Two patients (12.5%) died following vaccination without resuscitation attempts.
CONCLUSIONS: TTS is a rare but potentially life-threatening complication of vaccination. Typical TTS symptoms such as chest pain and dyspnoea should be considered alarming symptoms, though nonspecific symptoms are common. The risks of such rare adverse events should be balanced against the risks of infection.
摘要：
目的：Takotsubo综合征（TTS）是疫苗接种的罕见并发症。在这项研究中,我们试图深入了解已报道的疫苗接种诱导的TTS的特征.
结果：我们进行了系统综述，搜索PubMed,Embase,WebofScience,OvidMEDLINE,日志@Ovid,和截至2023年4月26日的Scopus数据库，以确定疫苗诱导的TTS的病例报告或病例系列。然后，我们从这些报告中提取并总结了数据。确认了18份报告，共有19例TTS患者与疫苗接种相关。在19名患者中，大多数为女性（n=13，68.4％），平均年龄为56.6±21.9岁。2019年冠状病毒病疫苗接种后，17名患者出现TTS，其中14人接受了mRNA疫苗接种。2例TTS发生在流感疫苗接种后。在19名患者中，17例（89.5％）完成了经胸超声心动图检查，16例（84.2％）进行了血管造影。7例患者（36.8%）完成了心脏磁共振成像。症状发作的中位时间为2(四分位数间距，1-4）天。最常见的症状是胸痛（68.4%），呼吸困难（57.9％），和消化症状（31.6%）。57.9%的患者出现了疲劳等非特异性症状,肌痛，排汗,和发烧。在报告的16例TTS病例中，15例患者（93.8%）表现出升高的心肌肌钙蛋白水平，在报告的9起案件中，8例患者(88.9%)的利钠肽水平升高.所有患者均有心电图改变：ST段改变（47.1%），T波反演(58.8%),校正QT间期延长(35.3%)。最常见的TTS类型是根尖膨胀（88.2％）。住院期间的治疗通常包括β受体阻滞剂（44.4%），血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（33.3％），和利尿剂(22.2%)。治疗后,81.3%的患者症状好转出院。在这个群体中,据报道,9例患者(56.3%)在随访期间室壁运动恢复.两名患者（12.5％）在未尝试复苏的情况下接种疫苗后死亡。
结论：TTS是一种罕见但可能危及生命的疫苗接种并发症。典型的TTS症状，如胸痛和呼吸困难应被视为令人震惊的症状，尽管非特异性症状很常见。此类罕见不良事件的风险应与感染风险相平衡。
结果：我们进行了系统综述，搜索PubMed,Embase,WebofScience,OvidMEDLINE,日志@Ovid,和截至2023年4月26日的Scopus数据库，以确定疫苗诱导的TTS的病例报告或病例系列。然后，我们从这些报告中提取并总结了数据。确认了18份报告，共有19例TTS患者与疫苗接种相关。在19名患者中，大多数为女性（n=13，68.4％），平均年龄为56.6±21.9岁。2019年冠状病毒病疫苗接种后，17名患者出现TTS，其中14人接受了mRNA疫苗接种。2例TTS发生在流感疫苗接种后。在19名患者中，17例（89.5％）完成了经胸超声心动图检查，16例（84.2％）进行了血管造影。7例患者（36.8%）完成了心脏磁共振成像。症状发作的中位时间为2(四分位数间距，1-4）天。最常见的症状是胸痛（68.4%），呼吸困难（57.9％），和消化症状（31.6%）。57.9%的患者出现了疲劳等非特异性症状,肌痛，排汗,和发烧。在报告的16例TTS病例中，15例患者（93.8%）表现出升高的心肌肌钙蛋白水平，在报告的9起案件中，8例患者(88.9%)的利钠肽水平升高.所有患者均有心电图改变：ST段改变（47.1%），T波反演(58.8%),校正QT间期延长(35.3%)。最常见的TTS类型是根尖膨胀（88.2％）。住院期间的治疗通常包括β受体阻滞剂（44.4%），血管紧张素转换酶抑制剂/血管紧张素受体阻滞剂（33.3％），和利尿剂(22.2%)。治疗后,81.3%的患者症状好转出院。在这个群体中,据报道,9例患者(56.3%)在随访期间室壁运动恢复.两名患者（12.5％）在未尝试复苏的情况下接种疫苗后死亡。
结论：TTS是一种罕见但可能危及生命的疫苗接种并发症。典型的TTS症状，如胸痛和呼吸困难应被视为令人震惊的症状，尽管非特异性症状很常见。此类罕见不良事件的风险应与感染风险相平衡。
