스트레스 유발성 심근증 환자들의 원내 사망과 좌심실 기능 회복의 예측인자
Predictors of In-Hospital Mortality and Left Ventricular Functional Recovery in Korean Patients with Stress-Induced Cardiomyopathy: Stress-Induced Cardiomyopathy Registry Data
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목적: 스트레스 유발성 심근병증은 최근까지 그 빈도가 증가하고 있다. 그러나 아직까지 다기관 등록 자료를 통한 연구가 없었고, 또한 원내 사망률과 좌심실 수축기능의 회복과 관련된 예후인자에 대한 연구는 없었다. 본 연구는 한국 내 다기관 등록자료를 통하여 스트레스 유발성 심근병증 환자에 있어서 원내 사망률과 좌심실 수축기능의 회복과 관련된 예측인자에는 어떠한 것이 있는지 알아보고자 하였다. 방법: 2004년 11월부터 2010년 11월까지 한국 내 8개 병원에서 후향적으로 수집하여, Mayo Clinic에서 제안하는 네 가지 임상적인 진단 요건을 만족하는 총 155명의 환자들을 대상으로 하였다. 기본적인 임상자료들과 검사실 결과들을 분석하였고, 발병 당시와 일주일 후 추적 심초음파 검사를 시행하여 좌심실 구혈률 및 WMSI 등을 비교하였으며, 원내 사망 및 재발 등을 측정하였다. 통계분석은 t-검정(독립 표본), 교차분석, 로지스틱 회귀분석 등을 사용하였다. 결과: 총 8명(5.2%)의 원내 사망이 있었고, 원내 사망과 관련된 의미 있는 예측인자는 초기의 높은 혈소판 수치였다. 좌심실 구혈률의 회복과 관련된 의미 있는 예측인자는 없었고, WMSI의 회복과 관련된 의미 있는 예측인자는 발병 당시 부정맥의 부재와 초기 좌심실 수축기 말 직경이 큰 경우였다. 결론: 발병 당시 부정맥이 발생하지 않고 좌심실 수축기말 직경이 큰 경우에 시기 적절한 좌심실 수축기능의 회복을 좀 더 기대해 볼 수 있었다.
Abstract
Background/Aims:The reported frequency of stress-induced cardiomyopathy (SCMP, Takotsubo cardiomyopathy) is increasing; however, there are no data regarding predictors of in-hospital mortality and the recovery of left ventricular (LV) systolic function in patients with SCMP. Therefore, in this study, we sought to identify clinical predictors of in-hospital mortality and of the recovery of LV dysfunction in Korean patients with SCMP. Methods:From November 2004 to November 2010, 155 patients who fulfilled the clinical diagnostic criteria of the Mayo clinic for SCMP were enrolled retrospectively from eight medical centers in Korea. We checked in-hospital deaths and compared the LV ejection fraction (LVEF) and wall-motion score index (WMSI) upon enrollment for each patient with that after 1 week using echocardiograms. A total of 55 continuous variables and 52 nominal variables were analyzed to find variables associated with in-hospital mortality and the recovery of LV dysfunction. All significant variables were entered into a logistic regression analysis. Results:The mean age of the patients was 64 ± 15 years; 118 (76.1%) patients were female. The in-hospital mortality rate was 5.2% (n = 8). An elevated initial platelet count was identified as a predictor of in-hospital mortality (odds ratio [95% CI]: 0.99 [0.99-1.00]). There were no predictors of the recovery of LVEF. Predictors of the recovery of WMSI were an absence of arrhythmic events (odds ratio [95% CI]: 22.89 [1.98-265.34]) and an elevated initial LV end-systolic diameter (odds ratio [95% CI]: 0.86 [0.74-1.00]). Conclusions:An initial absence of arrhythmic events and elevated LV end-diastolic pressure in patients with SCMP may be predictors of the timely recovery of LV dysfunction. (Korean J Med 2011;81:64-72)
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