医学
预加载
射血分数
心脏病学
内科学
优势比
置信区间
心力衰竭
逻辑回归
心导管术
作者
Marco Giuseppe Del Buono,Rocco A. Montone,Maria Chiara Meucci,Giulia La Vecchia,Massimiliano Camilli,Luca Giraldi,Daniela Pedicino,Carlo Trani,Tommaso Sanna,Leonarda Galiuto,Giampaolo Niccoli,Filippo Crea
出处
期刊:European heart journal. Acute cardiovascular care
[Oxford University Press]
日期:2021-08-24
卷期号:10 (6): 661-667
被引量:2
标识
DOI:10.1093/ehjacc/zuab028
摘要
Takotsubo syndrome (TTS) is associated to serious adverse in-hospital complications. We evaluated the role of invasively assessed left ventricular end-diastolic pressure (LVEDP) for predicting in-hospital complications in TTS patients compared to the most widely used echocardiographic parameters of ventricular function.We prospectively enrolled 130 patients (mean age 71.2 ± 11.3 years, 114 [87.7%] female) with TTS. Invasive measurement of LVEDP was performed at the time of cardiac catheterization. The rate of in-hospital complications (composite of acute heart failure, life-threatening arrhythmias and all-cause death) was examined. In-hospital complications occurred in 37 (28.5%) patients. Patients who experienced in-hospital complications had a higher prevalence of neurological trigger and lower prevalence of emotional trigger, higher LVEDP and mean E/e' ratio and lower LV ejection fraction (LVEF) values compared to those who did not experience in-hospital complications. At multivariate logistic regression, higher LVEDP [odds ratio (OR) 1.12, 95% confidence interval (CI) [1.05-1.20], P < 0.001] and lower LVEF (OR 0.95, 95% CI [0.91-0.99], P = 0.011) remained independently predictors of in-hospital complications, while emotional trigger was associated to a lower risk (OR 0.24, 95% CI [0.06-0.96], P = 0.044). The area under the curve (AUC) for LEVDP in the prediction of in-hospital events was 0.776 (95% CI [0.69-0.86], P <0.001, with a sensitivity and specificity of 95% and 58% using a LVEDP cut-off value of 22.5 mmHg). The AUC was significantly higher for LVEDP than for E/e' ratio (P = 0.037).LVEDP measured at the time of catheterization may help in identifying TTS patients at higher risk of cardiovascular deterioration with relevant therapeutic implications.
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