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Снижение глобальной тканевой деформации левого желудочка как причина сердечной недостаточности и ухудшения качества жизни больных с синдромом такоцубо в отдалённом периоде заболевания: проспективное когортное исследование
Снижение глобальной тканевой деформации левого желудочка как причина сердечной недостаточности и ухудшения качества жизни больных с синдромом такоцубо в отдалённом периоде заболевания: проспективное когортное исследование
Евдокимов Д.С., Болдуева С.А., Феоктистова В.С. Снижение глобальной тканевой деформации левого желудочка как причина сердечной недостаточности и ухудшения качества жизни больных с синдромом такоцубо в отдалённом периоде заболевания: проспективное когортное исследование. CardioСоматика. 2022. Т. 13, № 3. С. 132–138. DOI: https://doi.org/10.17816/CS133707
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Аннотация
Цель. Оценить выраженность хронической сердечной недостаточности (ХСН), фракцию выброса (ФВ) и глобальную сократимость левого желудочка (ЛЖ) при помощи методики speckle tracking (STE) у пациентов с синдромом такоцубо (СТ) в раннем и отдалённом периоде заболевания и сопоставить эти данные с оценкой качества жизни (КЖ) больных.
Материал и методы. В проспективное когортное исследование включены 60 пациентов с СТ, средний возраст 65,5±13,4 года. Выраженность симптомов ХСН оценивали по шкале оценки клинического состояния при ХСН (ШОКС). Для изучения КЖ использовали Миннесотский опросник (MLHFQ) и опросник HeartQol. Данные эхокардиографии (ЭхоКГ) регистрировали в острый период заболевания и при выписке из стационара; в отдалённом периоде заболевания выполняли ЭхоКГ с методикой STE. Через 1 год проводили исследование эндотелиальной функции на аппарате «EndoPAT 2000» с определением индекса реактивной гиперемии (RHI).
Результаты. По шкале ШОКС у всех пациентов с СТ в отдалённом периоде заболевания выраженность симптомов ХСН соответствовала 1–2 функциональному классу (ФК) по классификации NYHA (New York Heart Association, Нью-Йоркская кардиологическая ассоциация) при том, что исходно, до развития СТ, только у 15 человек имелись признаки ХСН на уровне 1–2 ФК. По данным ЭхоКГ, ФВ ЛЖ у больных с СТ при поступлении составила 44,5±9,7%, при выписке – 60,2±7,6%, через 1 год – 61,6±9,2%, через 2 года – 60,0±9,0%. Средние значения показателей глобальной продольной и глобальной циркулярной деформации ЛЖ у пациентов с СТ через 1 год от момента возникновения заболевания находились на уровне 14,0±3,1 и 15,0±4,1% соответственно, а спустя 2 года составляли 12,3±1,9 и 13,1±1,9% соответственно. При сравнении данных опросников MLHFQ и HeartQol установлено, что КЖ в отдалённом периоде СТ было статистически значимо ниже, чем исходное, до развития заболевания. Средние значения RHI через 1 год составили 1,74±0,19.
Заключение. Несмотря на полное восстановление ФВ ЛЖ у больных с СТ сохраняются клинические проявления, характерные для ХСН. При помощи методики STE в отдалённом периоде заболевания более чем у 90% пациентов выявлены нарушения глобальной тканевой деформации ЛЖ. Эти изменения могут объяснить клинические проявления ХСН и снижение КЖ у больных с СТ в отдалённом периоде заболевания.
Ключевые слова: синдром такоцубо, сердечная недостаточность, прогноз, эхокардиография, качество жизни
Material and methods. The study included 60 patients with TS, with a mean age of 65.5±13.4 years. The severity of CHF symptoms was assessed using the SHOKS scale (assessment of the clinical condition in CHF). The Minnesota Questionnaire and the HeartQol questionnaire were used to study QoL. Echocardiography data (ECHOCG) were recorded during the acute period and at discharge from the hospital. In the late disease period, ECHOCG was performed using the STE method. After 1 year, endothelial function was studied using the EndoPAT 2000 device to determine the reactive hyperemia index.
Results. According to the SHOKS scale, the severity of CHF symptoms corresponded to 1–2 functional class (FC) in all patients with TS in the long-term disease; however, before the development of TS, only 15 people had signs of CHF at the level of 1–2 fc. According to ECHOCG, LVEF in patients with TS was 44.5±9.7% at admission, 60.2±7.6% at discharge, 61.6±9.2% after a year, and 60.0±9.0% after 2 years. The average values of global longitudinal and global circular deformation of the left ventricle in patients with TS were 14.0±3.1 and 15.0±4.1%, respectively, after 1 year from disease onset and 12.3±1.9 and 13.1±1.9%, respectively, after 2 years. When comparing the data of the Minnesota Questionnaire and HeartQol questionnaires, QoL in the long-term of ST was significantly lower than the initial one before disease development. Mean reactive hyperemia index values after 1 year were 1.74±0.19.
Conclusion. Despite the complete restoration of LVEF in patients with TS, clinical manifestations of CHF persist. Using the STE technique during the long term, >90% of patients had abnormalities in the global tissue deformity of the left ventricle. These changes may explain the CHF clinical manifestations and QoL decrease in patients with TS during long-term disease.
Keywords: takotsubo syndrome, heart failure, prognosis, echocardiography, quality of life
Материал и методы. В проспективное когортное исследование включены 60 пациентов с СТ, средний возраст 65,5±13,4 года. Выраженность симптомов ХСН оценивали по шкале оценки клинического состояния при ХСН (ШОКС). Для изучения КЖ использовали Миннесотский опросник (MLHFQ) и опросник HeartQol. Данные эхокардиографии (ЭхоКГ) регистрировали в острый период заболевания и при выписке из стационара; в отдалённом периоде заболевания выполняли ЭхоКГ с методикой STE. Через 1 год проводили исследование эндотелиальной функции на аппарате «EndoPAT 2000» с определением индекса реактивной гиперемии (RHI).
Результаты. По шкале ШОКС у всех пациентов с СТ в отдалённом периоде заболевания выраженность симптомов ХСН соответствовала 1–2 функциональному классу (ФК) по классификации NYHA (New York Heart Association, Нью-Йоркская кардиологическая ассоциация) при том, что исходно, до развития СТ, только у 15 человек имелись признаки ХСН на уровне 1–2 ФК. По данным ЭхоКГ, ФВ ЛЖ у больных с СТ при поступлении составила 44,5±9,7%, при выписке – 60,2±7,6%, через 1 год – 61,6±9,2%, через 2 года – 60,0±9,0%. Средние значения показателей глобальной продольной и глобальной циркулярной деформации ЛЖ у пациентов с СТ через 1 год от момента возникновения заболевания находились на уровне 14,0±3,1 и 15,0±4,1% соответственно, а спустя 2 года составляли 12,3±1,9 и 13,1±1,9% соответственно. При сравнении данных опросников MLHFQ и HeartQol установлено, что КЖ в отдалённом периоде СТ было статистически значимо ниже, чем исходное, до развития заболевания. Средние значения RHI через 1 год составили 1,74±0,19.
Заключение. Несмотря на полное восстановление ФВ ЛЖ у больных с СТ сохраняются клинические проявления, характерные для ХСН. При помощи методики STE в отдалённом периоде заболевания более чем у 90% пациентов выявлены нарушения глобальной тканевой деформации ЛЖ. Эти изменения могут объяснить клинические проявления ХСН и снижение КЖ у больных с СТ в отдалённом периоде заболевания.
Ключевые слова: синдром такоцубо, сердечная недостаточность, прогноз, эхокардиография, качество жизни
________________________________________________
Material and methods. The study included 60 patients with TS, with a mean age of 65.5±13.4 years. The severity of CHF symptoms was assessed using the SHOKS scale (assessment of the clinical condition in CHF). The Minnesota Questionnaire and the HeartQol questionnaire were used to study QoL. Echocardiography data (ECHOCG) were recorded during the acute period and at discharge from the hospital. In the late disease period, ECHOCG was performed using the STE method. After 1 year, endothelial function was studied using the EndoPAT 2000 device to determine the reactive hyperemia index.
Results. According to the SHOKS scale, the severity of CHF symptoms corresponded to 1–2 functional class (FC) in all patients with TS in the long-term disease; however, before the development of TS, only 15 people had signs of CHF at the level of 1–2 fc. According to ECHOCG, LVEF in patients with TS was 44.5±9.7% at admission, 60.2±7.6% at discharge, 61.6±9.2% after a year, and 60.0±9.0% after 2 years. The average values of global longitudinal and global circular deformation of the left ventricle in patients with TS were 14.0±3.1 and 15.0±4.1%, respectively, after 1 year from disease onset and 12.3±1.9 and 13.1±1.9%, respectively, after 2 years. When comparing the data of the Minnesota Questionnaire and HeartQol questionnaires, QoL in the long-term of ST was significantly lower than the initial one before disease development. Mean reactive hyperemia index values after 1 year were 1.74±0.19.
Conclusion. Despite the complete restoration of LVEF in patients with TS, clinical manifestations of CHF persist. Using the STE technique during the long term, >90% of patients had abnormalities in the global tissue deformity of the left ventricle. These changes may explain the CHF clinical manifestations and QoL decrease in patients with TS during long-term disease.
Keywords: takotsubo syndrome, heart failure, prognosis, echocardiography, quality of life
Полный текст
Список литературы
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3. Templin C, Ghadri JR, Diekmann J, et al. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. N Engl J Med. 2015;373(10):929–938. doi: 10.1056/NEJMoa1406761
4. Neil CJ, Nguyen TH, Singh K, et al. Relation of delayed recovery of myocardial function after takotsubo cardiomyopathy to subsequent quality of life. Am J Cardiol. 2015;115(8):1085–1089. doi: 10.1016/j.amjcard.2015.01.541
5. Zilberman L, Zalik A, Fugenfirov I, et al. Residual alterations of cardiac and endothelial function in patients who recovered from Takotsubo cardiomyopathy. Clin Cardiol. 2021;44(6):797–804. doi: 10.1002/clc.23604
6. Lee M. Time Course of Functional Recovery in Takotsubo (Stress) Cardiomyopathy: A Serial Speckle Tracking Echocardiography and Electrocardiography Study. J Cardiovasc Imaging. 2020;28(1):50–60. doi: 10.4250/jcvi.2019.0083
7. Scally C, Rudd A, Mezincescu A, et al. Persistent Long-Term Structural, Functional, and Metabolic Changes After Stress-Induced (Takotsubo) Cardiomyopathy. Circulation. 2018;137(10):1039–1048. doi: 10.1161/CIRCULATIONAHA.117.031841
8. Bilbao A, Escobar A, García-Perez L, et al. The Minnesota living with heart failure questionnaire: comparison of different factor structures. Health Qual Life Outcomes. 2016;14:23.
doi: 10.1186/s12955-016-0425-7
9. Oldridge N, Höfer S, McGee H, et al. The HeartQoL: Part I. Development of a new core health-related quality of life questionnaire for patients with ischemic heart disease. Eur J Prev Cardiol. 2014;21(1):90–97. doi: 10.1177/2047487312450544
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12. Lang RM, Badano LP, Mor-Avi V. Recommendations for Cardiac Chamber Quantifi cation by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1–39. doi: 10.1016/j.echo.2014.10.003
13. Wittstein IS, Thiemann DR, Lima JA, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005;352(6):539–548.
doi: 10.1056/NEJMoa043046
14. Schwarz K, Ahearn T, Srinivasan J, et al. Alterations in Cardiac Deformation, Timing of Contraction and Relaxation, and Early Myocardial Fibrosis Accompany the Apparent Recovery of Acute Stress-Induced (Takotsubo) Cardiomyopathy: An End to the Concept of Transience. J Am Soc Echocardiogr. 2017;30(8):745–755. doi: 10.1016/j.echo.2017.03.016
15. Gaede L, Herchenbach A, Tröbs M, et al. Left ventricular contraction patterns in Takotsubo Syndrome and their correlation with long-term clinical outcome. Int J Cardiol Heart Vasc. 2021;32:100708. doi: 10.1016/j.ijcha.2020.100708
16. Matsushita K, Lachmet-Thébaud L, Marchandot B, et al. Incomplete Recovery From Takotsubo Syndrome Is a Major Determinant of Cardiovascular Mortality. Circ J. 2021;85(10):1823–1831. doi: 10.1253/circj.CJ-20-1116
17. Nguyen TH, Neil CJ, Sverdlov AL, et al. N-terminal pro-brain natriuretic protein levels in takotsubo cardiomyopathy. Am J Cardiol. 2011;108(9):1316–1321.
doi: 10.1016/j.amjcard.2011.06.047
18. Butt JH, Bang LE, Rørth R, et al. Long-term Risk of Death and Hospitalization in Patients With Heart Failure and Takotsubo Syndrome: Insights From a Nationwide Cohort. J Card Fail. 2022;28(10):1534–1544. doi: 10.1016/j.cardfail.2022.02.002
19. Bonetti PO, Pumper GM, Higano ST, et al. Noninvasive Identification of Patients with Early Coronary Atherosclerosis by Assessment of Digital Reactive Hyperemia. J Am Coll Cardiol. 2004;44(11):2137–2141. doi: 10.1016/ j.jacc.2004. 08.062
20. Bugiardini R, Bairey Merz CN. Angina with «normal» coronary arteries: a changing philosophy. JAMA. 2005;293(4):477–484. doi: 10.1001/jama.293.4.477
21. Matsuzawa Y, Sugiyama S, Sugamura K, et al. Digital assessment of endothelial function and ischemic heart disease in women. J Am Coll Cardiol. 2010;55(16):1688–1696.
doi: 10.1016/j.jacc.2009.10.073
22. Selamet Tierney ES, Newburger JW, Gauvreau K, et al. Endothelial pulse amplitude testing: feasibility and reproducibility in adolescents. J Pediatr. 2009;154(6):901–905.
doi: 10.1016/j.jpeds.2008.12.028
23. Aldiwani H, Nelson MD, Sharif B, et al. Reduced myocardial perfusion is common among subjects with ischemia and no obstructive coronary artery disease and heart failure with preserved ejection fraction: a report from the WISE-CVD continuation study. Vessel Plus. 2022;6:16. doi: 10.20517/2574-1209.2021.103
24. Singh K, Carson K, Usmani Z, et al. Systematic review and meta-analysis of incidence and correlates of recurrence of takotsubo cardiomyopathy. Int J Cardiol. 2014;174(3):696–701. doi: 10.1016/j.ijcard.2014.04.221
2. Ghadri J.R., Wittstein I.S., Prasad A., et al. International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology // Eur Heart J. 2018. Vol. 39, N 22. P. 2032–2046. doi: 10.1093/eurheartj/ehy076
3. Templin C., Ghadri J.R., Diekmann J., et al. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy // N Engl J Med. 2015. Vol. 373, N 10. P. 929–938.
doi: 10.1056/NEJMoa1406761
4. Neil C.J., Nguyen T.H., Singh K., et al. Relation of delayed recovery of myocardial function after takotsubo cardiomyopathy to subsequent quality of life // Am J Cardiol. 2015. Vol. 115, N 8. P. 1085–1089. doi: 10.1016/j.amjcard.2015.01.541
5. Zilberman L., Zalik A., Fugenfirov I., et al. Residual alterations of cardiac and endothelial function in patients who recovered from Takotsubo cardiomyopathy // Clin Cardiol. 2021. Vol. 44, N 6. P. 797–804. doi: 10.1002/clc.23604
6. Lee M. Time Course of Functional Recovery in Takotsubo (Stress) Cardiomyopathy: A Serial Speckle Tracking Echocardiography and Electrocardiography Study // J Cardiovasc Imaging. 2020. Vol. 28, N 1. P. 50–60. doi: 10.4250/jcvi.2019.0083
7. Scally C., Rudd A., Mezincescu A., et al. Persistent Long-Term Structural, Functional, and Metabolic Changes After Stress-Induced (Takotsubo) Cardiomyopathy // Circulation. 2018. Vol. 137, N 10. P. 1039–1048. doi: 10.1161/CIRCULATIONAHA.117.031841
8. Bilbao A., Escobar A., García-Perez L., et al. The Minnesota living with heart failure questionnaire: comparison of different factor structures // Health Qual Life Outcomes. 2016. N 14. P. 23. doi: 10.1186/s12955-016-0425-7
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2. Ghadri JR, Wittstein IS, Prasad A, et al. International Expert Consensus Document on Takotsubo Syndrome (Part I): Clinical Characteristics, Diagnostic Criteria, and Pathophysiology. Eur Heart J. 2018;39(22):2032–2046. doi: 10.1093/eurheartj/ehy076
3. Templin C, Ghadri JR, Diekmann J, et al. Clinical Features and Outcomes of Takotsubo (Stress) Cardiomyopathy. N Engl J Med. 2015;373(10):929–938. doi: 10.1056/NEJMoa1406761
4. Neil CJ, Nguyen TH, Singh K, et al. Relation of delayed recovery of myocardial function after takotsubo cardiomyopathy to subsequent quality of life. Am J Cardiol. 2015;115(8):1085–1089. doi: 10.1016/j.amjcard.2015.01.541
5. Zilberman L, Zalik A, Fugenfirov I, et al. Residual alterations of cardiac and endothelial function in patients who recovered from Takotsubo cardiomyopathy. Clin Cardiol. 2021;44(6):797–804. doi: 10.1002/clc.23604
6. Lee M. Time Course of Functional Recovery in Takotsubo (Stress) Cardiomyopathy: A Serial Speckle Tracking Echocardiography and Electrocardiography Study. J Cardiovasc Imaging. 2020;28(1):50–60. doi: 10.4250/jcvi.2019.0083
7. Scally C, Rudd A, Mezincescu A, et al. Persistent Long-Term Structural, Functional, and Metabolic Changes After Stress-Induced (Takotsubo) Cardiomyopathy. Circulation. 2018;137(10):1039–1048. doi: 10.1161/CIRCULATIONAHA.117.031841
8. Bilbao A, Escobar A, García-Perez L, et al. The Minnesota living with heart failure questionnaire: comparison of different factor structures. Health Qual Life Outcomes. 2016;14:23.
doi: 10.1186/s12955-016-0425-7
9. Oldridge N, Höfer S, McGee H, et al. The HeartQoL: Part I. Development of a new core health-related quality of life questionnaire for patients with ischemic heart disease. Eur J Prev Cardiol. 2014;21(1):90–97. doi: 10.1177/2047487312450544
10. Itamar Medical Device User Manual. Itamar Medical Ltd.; 2016. Available from: https://www.itamar-medical.com/wp-content/uploads/2019/07/OM1695214.pdf. Accessed: 22.02.2023.
11. Akramova EG. Clinical significance of left ventricular longitudinal deformation in coronary heart disease and non-coronary pathology. Kazan medical journal. 2019;100(2):295–302. doi: 10.17816/KMJ2019-295
12. Lang RM, Badano LP, Mor-Avi V. Recommendations for Cardiac Chamber Quantifi cation by Echocardiography in Adults: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1–39. doi: 10.1016/j.echo.2014.10.003
13. Wittstein IS, Thiemann DR, Lima JA, et al. Neurohumoral features of myocardial stunning due to sudden emotional stress. N Engl J Med. 2005;352(6):539–548.
doi: 10.1056/NEJMoa043046
14. Schwarz K, Ahearn T, Srinivasan J, et al. Alterations in Cardiac Deformation, Timing of Contraction and Relaxation, and Early Myocardial Fibrosis Accompany the Apparent Recovery of Acute Stress-Induced (Takotsubo) Cardiomyopathy: An End to the Concept of Transience. J Am Soc Echocardiogr. 2017;30(8):745–755. doi: 10.1016/j.echo.2017.03.016
15. Gaede L, Herchenbach A, Tröbs M, et al. Left ventricular contraction patterns in Takotsubo Syndrome and their correlation with long-term clinical outcome. Int J Cardiol Heart Vasc. 2021;32:100708. doi: 10.1016/j.ijcha.2020.100708
16. Matsushita K, Lachmet-Thébaud L, Marchandot B, et al. Incomplete Recovery From Takotsubo Syndrome Is a Major Determinant of Cardiovascular Mortality. Circ J. 2021;85(10):1823–1831. doi: 10.1253/circj.CJ-20-1116
17. Nguyen TH, Neil CJ, Sverdlov AL, et al. N-terminal pro-brain natriuretic protein levels in takotsubo cardiomyopathy. Am J Cardiol. 2011;108(9):1316–1321.
doi: 10.1016/j.amjcard.2011.06.047
18. Butt JH, Bang LE, Rørth R, et al. Long-term Risk of Death and Hospitalization in Patients With Heart Failure and Takotsubo Syndrome: Insights From a Nationwide Cohort. J Card Fail. 2022;28(10):1534–1544. doi: 10.1016/j.cardfail.2022.02.002
19. Bonetti PO, Pumper GM, Higano ST, et al. Noninvasive Identification of Patients with Early Coronary Atherosclerosis by Assessment of Digital Reactive Hyperemia. J Am Coll Cardiol. 2004;44(11):2137–2141. doi: 10.1016/ j.jacc.2004. 08.062
20. Bugiardini R, Bairey Merz CN. Angina with «normal» coronary arteries: a changing philosophy. JAMA. 2005;293(4):477–484. doi: 10.1001/jama.293.4.477
21. Matsuzawa Y, Sugiyama S, Sugamura K, et al. Digital assessment of endothelial function and ischemic heart disease in women. J Am Coll Cardiol. 2010;55(16):1688–1696.
doi: 10.1016/j.jacc.2009.10.073
22. Selamet Tierney ES, Newburger JW, Gauvreau K, et al. Endothelial pulse amplitude testing: feasibility and reproducibility in adolescents. J Pediatr. 2009;154(6):901–905.
doi: 10.1016/j.jpeds.2008.12.028
23. Aldiwani H, Nelson MD, Sharif B, et al. Reduced myocardial perfusion is common among subjects with ischemia and no obstructive coronary artery disease and heart failure with preserved ejection fraction: a report from the WISE-CVD continuation study. Vessel Plus. 2022;6:16. doi: 10.20517/2574-1209.2021.103
24. Singh K, Carson K, Usmani Z, et al. Systematic review and meta-analysis of incidence and correlates of recurrence of takotsubo cardiomyopathy. Int J Cardiol. 2014;174(3):696–701. doi: 10.1016/j.ijcard.2014.04.221
Авторы
Д.С. Евдокимов*, С.А. Болдуева, В.С. Феоктистова
ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России, Санкт-Петербург, Россия
*kasabian244@gmail.com
Mechnikov North-Western State Medical University, St. Petersburg, Russia
*kasabian244@gmail.com
ФГБОУ ВО «Северо-Западный государственный медицинский университет им. И.И. Мечникова» Минздрава России, Санкт-Петербург, Россия
*kasabian244@gmail.com
________________________________________________
Mechnikov North-Western State Medical University, St. Petersburg, Russia
*kasabian244@gmail.com
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