Comparison on the clinical characteristics of patients with Takotsubo syndrome from China and from Europe/North America / 中华心血管病杂志

Objective: To summarize the clinical characteristics of patients with Takotsubo syndrome (TTS) from China and compare these features with patients from Europe/North America. Methods: We reviewed case reports published between 1990 and 2020 with the key words of "Takotsubo syndrome" "stress cardiomyopathy" "apical balloon syndrome" and "broken heart syndrome", in Wanfang, CNKI, Pubmed and Web of Science databases, and 1 294 articles were identified, including 128 articles reporting 163 cases in China and 1 166 articles reporting 1 256 cases in Europe/North America. The characteristics of demographics, triggers, symptoms, electrocardiogram, echocardiography, left ventriculogram,coronary angiography, treatment and prognosis were analyzed and compared between Chinese and European/North American cases. Results: A total of 1 294 articles (1 419 cases: 163 from China, 1 256 from Europe/North America) were included in the final analysis. The characteristics of Chinese cases included: (1) demographic:the age was (59.6±16.9) years, which was similar with that of European/North American ((59.7±17.4) years, P=0.90), and female accounting for 78.5% (128/163), which was lower than that of European/North American (85.4% (1 073/1 256), P=0.02). (2) Triggers:mental triggers accounted for 48.5% (79/163), physical triggers accounted for 43.6% (71/163), and no triggers accounted for 7.9% (13/163), respectively. Compared with Europe/North America, the ratio of patients with mental triggers was higher in China, while the ratio of patients with physical triggers and no triggers was lower (P<0.05). (3) Symptoms: chest pain (52.8% (86/163)), chest tightness (35.0% (57/163)), shortness of breath (33.1% (54/163)), dizziness (16.0% (26/163)), sweating (15.3% (25/163)), palpitations (12.3% (20/163)), syncope (9.2% (15/163)) abdominal pain/diarrhea (8.6% (14/163)), hypotension (7.4% (12/163)), and fatigue (1.2% (2/163)) were illustrated in sequence. Compared with patients in Europe/North America, the ratio of patients with chest tightness, dizziness, sweating, palpitations, abdominal pain/diarrhea was higher in Chinese patients, while the ratio of patients with hypotension was lower in Chinese patients (P<0.05). (4) Electrocardiogram: main manifestations were myocardial ischemia symptoms, such as ST-segment elevation (63.8% (104/163)), T wave inversion (46.0% (75/163)), ST-segment depression (8.6% (14/163)). Compared with European/North American, the ratio of patients with ST-segment elevation, T wave inversion, and atrioventricular block was higher in Chinese patients (P<0.05). (5) Echocardiography and imaging:apical dyskinesia (59.5% (97/163)) and apical/left ventricular bulbar dilation (36.2%(59/163)) dominated the echocardiography findings. Compared with European/North American, the ratio of patients with apical dyskinesia, apical/left ventricular bulbar dilation, and mitral regurgitation was higher in Chinese patients, while the ratio of patients with dyskinesia in other parts and left ventricular ejection fraction<50% was lower in Chinese patients (P<0.05). Left ventricular angiography showed 36.2% (59/163) of apical dyskinesia in Chinese patients, which was higher than that reported in European/North American patients, and 38.7% (63/163) of apical/left ventricular bulbar dilation was reported in Chinese patients, which was similar to that reported in European/North American patients. Coronary angiography showed percent of no stenosis or stenosis less than 50% was 87.1% (142/163), which was similar to that reported in European/North American patients (P>0.05). The typical type of TTS accounted for 96.3% (157/163), which was significantly higher than that reported in European/ American patients, while the ratio of basal type and midventricular type was lower (P<0.01). (6) Treatment and prognosis:the applied drugs in China were listed in order as following, β-blockers (41.1% (67/163)), antiplatelet agents (37.4%(61/163)), ACEI/ARB (36.2%(59/163)), anticoagulants (27.0%(44/163)), diuretics (19.6% (32/163)), etc. Compared with Europe/North America, the ratio of antiplatelet agents, anticoagulants, statins, diuretics, and nitrates use was higher in China (P<0.05), while the use of oxygen therapy and IABP was similar (P>0.05). The hospital mortality in China was 5.5% (9/163), during 1-year follow-up the recurrence rate was 3.7% (6/163) and the mortality was 0. The prognosis was similar with that in Europe/North America. Conclusions: Compared with TTS cases in Europe/North America, TTS cases in China also occur usually in middle-aged and elderly women, most of whom have mental/physical triggers and typical imaging manifestations, followed by a low hospital mortality rate and recurrence rate.

Alien hand syndrome: contradictive movement and disorder of color discrimination.

A senile Chinese female patient with alien hand syndrome of vascular etiology is reported. This case exhibited contradictive movement, left-lateral paresis and disorder of color discrimination, which might be a new subtype of the alien limb syndrome.

Prevalência e estudo dos fatores associados à discinesia tardia no Centro Hospitalar Psiquiátrico de Barbacena (Minas Gerais) / Prevalence and study of associated factors in tardive dyskinesia in the Psychiatric Hospital Center of Barbacena (Minas Gerais)

A Discinesia Tardia (DT) representa uma séria complicação da terapia neuroléptica por seu caráter potencialmente irreversível, sua natureza iatrogênica e ausência do tratamento eficaz. Neste estudo, os autores investigam a prevalência e os fatores associados à DT por meio de inquérito clinico realizado em 310 pacientes crônicos, de ambos os sexos, internados no Centro Hospitalar Psiquiátrico de Barbacena. Os pacientes foram avaliados utilizando-se a escala AIMS (Abnormal Involuntary Movement Scale), analisando-se também outras variáveis, como sexo, idade, tempo de internação, uso de neurolépticos e diagnóstico psiquiátrico. Entre os pacientes estudados, 27,6% apresentaram sinais clínicos compatíveis com o diagnóstico de DT, sendo 54,2% do sexo feminino e 45,8% do sexo masculino. O tempo de internação, a idade e o uso de neurolépticos foram as variáveis relacionadas com a ocorrência de DT, não sendo observadas diferenças entre as demais variáveis pesquisadas.

Tardive dyskinesia (TD) is a serious complication of neuroleptic drug therapy, because of its irreversibiliry, lack of effective treatment and iatrogenic nature. In this article, the authors investigate the prevalence and associated factors of TD among 310 inpatients of Psychiatric Hospital Center of Barbacena, using the Abnormal Involuntary Movement Scale. Some variables such as sex, age, time of hospitalization, use of neuroleptics and psychiatric diagnosis were also analyzed. The prevalence of TD among the patients in the hospital was 27,6% and the distribution was: 54,2% in women and 45,8% of men. The time of hospitalization, the age and the use of neuroleptics were the only variables associated with the ocorrence of TD.