Correspondence on 'Outcomes of catecholamine and/or mechanical support in Takotsubo syndrome' by Terasaki et al

J. Madias
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引用次数: 1

Abstract

To the Editor: I enjoyed reading the report by Terasaki et al, about the 6169 patients with takotsubo syndrome (TTS) from the nationwide Japanese registry (JROADDPC) of all cardiac and vascular diseases, representing claims data of 4 years of registered patients, commenting on the particulars of patients with severe TTS (18.6%), who by definition necessitated catecholamines and/or mechanical support and patients with mild TTS, and the factors associated with complications and mortality. The authors found that the patients with severe TTS were more often male and had higher 30day inhospital mortality, Charlson scores, comorbid pneumonia, sepsis and higher ambulance use than patients with mild TTS, while mortality was increased with age. It has been previously theorised that the prevalence of diabetes mellitus (DM) may be lower in patients with TTS than in the general population, although others disagree with this notion. The implicit significance of this is that DM may exert a ‘protective effect’ towards the emergence of TTS, and in addition an ameliorating influence during hospitalisation (ie, ‘diabetes paradox’). 6 The overall prevalence of DM in the present study of patients with TTS was 14.1%, and DM was not a predictor of the severity of TTS in the univariate analysis (p=0.53), or 30day inhospital mortality (p=0.96). Since the study is based on a sizeable registry of >6000 patients, and is representative of the entire nation of Japan, it provides an opportunity to compare the prevalence of DM in patients with TTS (ie, 14.1%) with the prevalence of DM in the general Japanese population, particularly for women in their 60s and 70s, and the prevalence of DM in patients, again particularly for women in their 60s and 70s, admitted with other cardiac and vascular pathologies captured by the nationwide Japanese registry (JROADDPC). Indeed, it would be contributory to compare in parallel the corresponding DM prevalence of hypertension in the present study (42%) with the prevalence of hypertension in the general Japanese population, and in the patients admitted with other cardiac and vascular pathologies in the JROADDPC, particularly for women in their 60s and 70s, since hypertension is considered to be as frequent in patients with TTS, as in the general population, or in patients with other cardiac and vascular pathologies.
Terasaki等人关于“Takotsubo综合征儿茶酚胺和/或机械支持的结果”的对应关系
编者按:我很喜欢阅读Terasaki等人的报告,该报告涉及来自日本全国心脏和血管疾病登记处(JROADDPC)的6169名takotsubo综合征(TTS)患者,代表了4年登记患者的索赔数据,评论了严重TTS患者的详细信息(18.6%),根据定义需要儿茶酚胺和/或机械支持的患者和轻度TTS患者以及与并发症和死亡率相关的因素。作者发现,与轻度TTS患者相比,重度TTS患者通常是男性,30天住院死亡率、Charlson评分、合并肺炎、败血症和救护车使用率更高,而死亡率随着年龄的增长而增加。先前有理论认为,TTS患者的糖尿病(DM)患病率可能低于普通人群,尽管其他人不同意这一观点。这一点的隐含意义在于,糖尿病可能对TTS的出现产生“保护作用”,此外在住院期间也会产生改善作用(即“糖尿病悖论”)。6在本TTS患者研究中,糖尿病的总体患病率为14.1%,在单变量分析中,糖尿病不是TTS严重程度的预测因素(p=0.53)或30天住院死亡率的预测指标(p=0.96)。由于该研究基于>6000名患者的大规模登记,并且代表了整个日本,它提供了一个机会,可以将TTS患者的DM患病率(即14.1%)与日本普通人群的DM发病率进行比较,特别是60多岁和70多岁的女性,以及与日本全国注册中心(JROADDPC)记录的患有其他心脏和血管病的患者的DM发病例率进行比较。事实上,将本研究中相应的糖尿病高血压患病率(42%)与日本普通人群以及JROADDPC中患有其他心脏和血管疾病的患者的高血压患病率进行平行比较是有帮助的,尤其是60多岁和70多岁的女性,因为高血压被认为在TTS患者、普通人群或其他心脏和血管疾病患者中同样常见。
本文章由计算机程序翻译,如有差异,请以英文原文为准。
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