卒中合并Takotsubo综合征的临床影响
合并TTS者死亡率显著更高（21% vs 7.8%，p<0.001），女性、出血性卒中及合并症负担重是相关因素；出院时无TTS者30天非计划再入院中0.1%新诊断TTS，再入院期间死亡率更高（13% vs 6.5%，p=0.008）。
要点
- 卒中合并TTS虽罕见（0.18%）但死亡率高达21%，显著高于无TTS者。
- 女性、出血性卒中及合并症负担重是卒中合并TTS的强相关因素。
- 卒中后30天再入院中新发TTS者再入院期间死亡率更高（13% vs 6.5%）。
核心结论
- 卒中继发TTS虽罕见但高度致命，需早期识别和管理。
主要发现
- 6,119例（0.18%）发生卒中继发TTS，TTS组女性占79% vs 50%（p<0.001），中位年龄67 vs 70岁，出血性卒中比例更高（p<0.001），合并症负担更重。
- TTS合并卒中者死亡率21% vs 7.8%（p<0.001）。
- 再入院时新诊断TTS者女性占79% vs 50%，合并症负担更高，再入院期间死亡率13% vs 6.5%（p=0.008）。
临床怎么用
- 对卒中患者应警惕TTS的发生，尤其是女性、出血性卒中及合并症负担重者。
- 卒中后30天内再入院时需注意新发TTS的可能，及时识别以改善预后。
以上解读依据论文摘要（全文未开放获取或许可不允许翻译转载）。
原文
BACKGROUND: Data on outcomes of patients complicating with Takotsubo syndrome (TTS) following stroke, contributing factors and prognosis significance have not been well characterised. OBJECTIVE: To assess the incidence, factors and prognosis of TTS-complicated stroke, and to determine the 30-day unplanned readmission rates with TTS and its prognosis among stroke survivors without initial TTS. METHODS: The US Nationwide Readmission Database was queried using International Classification of Disease codes to gather information on individuals hospitalised with primary diagnosis of stroke between January 2010 and November 2021. Incidence, factors and prognosis associated with TTS-complicated stroke and 30-day unplanned readmissions with new TTS were assessed. The primary outcome was the occurrence of death during index admission for stroke as well as during readmission episode with TTS. Incidence, factors and prognosis associated with TTS-complicated stroke and 30-day unplanned readmissions with new TTS were assessed. RESULTS: Of 3 376 606 patients admitted with primary diagnosis of stroke, 6119 (0.18%) developed TTS secondary to stroke. Patients with TTS were more likely to be women (79% vs 50%, p<0.001), younger (median 67 vs 70 years), present with haemorrhagic (as opposed to ischaemic stroke, p<0.001) and have a higher comorbidity burden. The mortality rate was significantly higher in those who had TTS-complicated stroke (21% vs 7.8%, p<0.001). Of patients who were discharged without having TTS during the index admission, 217 745 (6.5%) patients had 30-day unplanned readmission, among these, 214 (0.1%) were readmitted with the new diagnosis of TTS. Patients who were readmitted with TTS were more likely to be women (79% vs 50%), had higher comorbidity burden and experienced higher mortality rate during readmission compared with those without TTS (13% vs 6.5%, p=0.008). CONCLUSION: Although rare, TTS secondary to stroke is highly fatal. Female sex, presentation with haemorrhagic stroke and pre-existing health conditions were strong factors associated with TTS-complicated stroke. Early recognition and management of TTS-complicated stroke are of paramount importance to prevent serious consequences.
引用
- Jang SS, Sposato L, Scheitz JF, et al. Clinical impact of Takotsubo syndrome in patients with stroke. Heart. 2026. PMID: 42045052. doi:10.1136/heartjnl-2025-327188
供执业医师工作参考，不替代临床判断；数值与分级以指南原文为准。