Transient left ventricular apical ballooning without coronary artery stenosis: A novel heart syndrome mimicking acute myocardial infarction
Transient left ventricular apical ballooning without coronary artery stenosis: A novel heart syndrome mimicking acute myocardial infarction
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DOI：
10.1016/s0735-1097(01)01316-x
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发表时间：
2001-07-01
影响因子：
24
通讯作者：
Morii, I
中科院分区：
文献类型：
--
作者：
Tsuchihashi, K;Ueshima, K;Morii, I
目的：为了确定一种新型心脏综合征伴有短暂性左室（LV）心尖球囊化，但无冠状动脉狭窄，模拟急性心肌梗死的临床特征，我们进行了一项多中心回顾性研究。背景：关于这种综合征，只有几个病例报告。方法我们分析了88例患者（男性12例，女性76例），年龄67 +/- 13岁，符合以下标准：1)短暂性左室根尖球囊，2)无明显血管造影狭窄，3)无已知心肌病。结果38例（43%）患者在发病时已有加重的基础疾病（脑血管意外[n = 3]、癫痫[n = 3]、加重支气管哮喘[n = 3]、急腹症[n = 7]）和非心脏手术或医疗程序（n = 11）。24例（27%）患者有情绪和身体问题（突发事故[n = 2]，家庭成员死亡/葬礼[n = 7]，缺乏运动经验[n = 6]，争吵或过度饮酒[n = 5]和剧烈兴奋[n = 4]）。胸部症状（67%）、心电图改变（ST段抬高[90%]、q波形成[27%]和t波倒置[97%]）和肌酸激酶升高（56%）。经肺水肿（22%）、心源性休克（15%）和室性心动过速/纤颤（9%）治疗后，85例患者出院时具有I级纽约心脏协会功能。左室射血分数从41 +/- 11%提高到64 +/- 10%。在13/72（18%）和10/48（21%）的患者中分别记录了短暂性脑室内压力梯度和诱发性血管痉挛。随访13 +/- 14个月，2例复发，1例猝死。结论报告了一例伴有短暂心尖球囊的新型心肌病。情绪或身体压力可能在这种心肌病中起关键作用，但是；确切的病因基础仍不清楚。CT Am Cell Cardiol 2001；38:11- 8) (C) 2001年由美国心脏病学会出版。
OBJECTIVES To determine the clinical features of a novel heart syndrome with transient left ventricular (LV) apical ballooning, but without coronary artery stenosis, that mimics acute myocardial infarction, we performed a multicenter retrospective enrollment study.BACKGROUND Only several case presentations have been reported with regard to this syndrome.METHODS We analyzed 88 patients (12 men and 76 women), aged 67 +/- 13 years, who fulfilled the following criteria: 1) transient LV apical ballooning, 2) no significant angiographic stenosis, and 3) no known cardiomyopathies.RESULTS Thirty-eight (43%) patients had preceding aggravation of underlying disorders (cerebrovascular accident [n = 3], epilepsy [n = 3], exacerbated bronchial asthma [n = 3], acute abdomen [n = 7]) and noncardiac surgery or medical procedure (n = 11) at the onset. Twenty-four (27%) patients had emotional and physical problems (sudden accident [n = 2], death/funeral of a family member [n = 7], inexperience with exercise [n = 6], quarreling or excessive alcohol consumption [n = 5] and vigorous excitation [n = 4]). Chest symptoms (67%), electrocardiographic changes (ST elevation [90%], Q-wave formation [27%] and T-wave inversion [97%]) and elevated creatine kinase (56%) were found. After treatment of pulmonary edema (22%), cardiogenic shock (15%) and ventricular tachycardia/fibrillation (9%), 85 patients had class I New York Heart Association function on discharge. The LV ejection fraction improved from 41 +/- 11% to 64 +/- 10%. Transient intraventricular pressure gradient and provocative vasospasm were documented in 13/72 (18%) and 10/48 (21%) of the patients, respectively. During follow-up for 13 +/- 14 months, two patients showed recurrence, and one died suddenly.CONCLUSIONS A novel cardiomyopathy with transient apical ballooning was reported. Emotional or physical stress might play a key role in this cardiomyopathy, but;he precise etiologic basis still remains unclear. CT Am Cell Cardiol 2001;38:11- 8) (C) 2001 by the American College of Cardiology.