背景:Takotsubo综合征(TS)是心力衰竭的可逆原因;然而,少数患者会出现严重的并发症,包括心脏破裂(CR)。
目的:分析与TS相关的CR病例报告,详细说明患者特征,以揭示这种严重并发症的危险因素和预后。
方法:我们对MEDLINE和Embase数据库进行了系统搜索,以确定TS并发CR患者的病例报告,从成立到2023年10月。
结果:我们纳入了44名受试者(40名女性;4名男性),中位年龄为75岁(71-82岁)。白人/高加索人(61%)或东亚/日本(39%)种族。在15位(34%)受试者中存在情绪触发因素,并且在所有情况下(100%)都观察到顶端膨胀模式。42例中有39例(93%)报告ST段抬高,心肌前段(37[88%])受损程度最高,其次是侧(26[62%])和下(14[33%])段。入院后心脏破裂的中位时间为48(5-120)小时,左心室游离壁25(57%)是最常见的穿孔部位。16例(36%)尝试手术,28例(64%)患者未存活。
结论:与TS相关的CR是一种罕见的并发症,与高死亡率相关,影响老年女性,特别是来自白人/高加索或东亚/日本血统,表现为前部或外侧ST段抬高,和顶端气球图案。尽管数据有限,还需要更多的前瞻性研究,对这种危及生命的并发症的认识对于早期识别高危患者至关重要.
结论:心脏破裂是Takotsubo综合征的一种罕见并发症。我们对并发心脏破裂的病例进行了系统回顾,我们确定了44名受试者(40名女性和4名男性),中位年龄为75(IQR71-82)岁,白人/高加索(61%)或东亚/日本(39%)种族,都有一个顶端膨胀的模式(100%)。入院后心脏破裂的中位时间为48(5-120)小时,左心室游离壁(25[57%])是最常见的穿孔部位。16例(36%)尝试手术治疗,28例(64%)患者未存活。
BACKGROUND: Takotsubo syndrome (TS) is a reversible cause of heart failure; however, a minority of patients can develop serious complications, including cardiac rupture (CR).
OBJECTIVE: Analyze case reports of CR related to TS, detailing patient characteristics to uncover risk factors and prognosis for this severe complication.
METHODS: We conducted a systematic search of MEDLINE and Embase databases to identify case reports of patients with TS complicated by CR, from inception to October 2023.
RESULTS: We included 44 subjects (40 females; 4 males) with a median age of 75 (IQR 71-82) years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity. An emotional trigger was present in 15 (34%) subjects and an apical ballooning pattern was observed in all cases (100%). ST-segment elevation was reported in 39 (93%) of 42 cases, with the anterior myocardial segments (37 [88%]) being the most compromised, followed by lateral (26 [62%]) and inferior (14 [33%]) segments. The median time to cardiac rupture was 48 (5-120) hours since admission, with the left ventricular free wall (25 [57%]) being the most frequent site of perforation. Surgery was attempted in 16 (36%) cases, and 28 (64%) patients did not survive.
CONCLUSIONS: CR related to TS is a rare complication associated with high mortality and affecting elderly females, specially from White/Caucasian or East Asian/Japanese descent, presenting with anterior or lateral ST-segment elevation, and an apical ballooning pattern. Although data is limited and additional prospective studies are needed, the awareness of this life-threatening complication is crucial to early identify high-risk patients.
CONCLUSIONS: Cardiac rupture is a rare complication of Takotsubo syndrome. We conducted a systematic review of cases complicated by cardiac rupture, and we identified 44 subjects (40 females and 4 males) with a median age of 75 (IQR 71-82) years, of White/Caucasian (61%) or East Asian/Japanese (39%) ethnicity, all with an apical ballooning pattern (100%). The median time to cardiac rupture was 48 (5-120) hours since admission, with the left ventricular free wall (25 [57%]) being the most frequent site of perforation. Surgery treatment was attempted in 16 (36%) cases, and 28 (64%) patients did not survive.