Use of cardiac MRI to diagnose Takotsubo syndrome.
Use of cardiac MRI to diagnose Takotsubo syndrome.
复制标题
使用心脏 MRI 诊断 Takotsubo 综合征。
DOI：
10.1038/nrcardio.2015.155
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发表时间：
2015
影响因子：
49.6
通讯作者：
Akashi YJ.
中科院分区：
文献类型：
--
作者：
Lyon AR;Akashi YJ.
亚历山大河里昂和明石义弘异常，冠状动脉正常（或无罪魁祸首冠状动脉疾病）。这些贝内包括诊断其他病理，如肥厚性心肌病、心肌炎、心肌炎、排除冠状动脉分布中的心肌梗死，以及与Takotsubo综合征解剖变异相关的典型圆周分布中的急性水肿或炎症证据。越来越多的报告和小系列表明在Takotsubo综合征的典型病例的功能障碍区段中T2 STIR（短Tau反转恢复）信号增加也有助于大量证据表明急性应激加重急性心肌炎症和/或水肿。正如我们的综述中所讨论的，活检证据也支持这一假设。此外，心脏MRI可用于识别与急性Takotsubo综合征相关的并发症，包括心尖血栓、右心室受累、心包炎和流出道梗阻。在实践中，根据诊断性冠状动脉造影、左心室造影或超声心动图的RWMA、心电图变化和临床表现，许多Tako tsubo综合征病例很容易识别。在这些患者中，常规使用心脏MRI不是必需的，但可以在可用的情况下使用。然而，许多病例并不直接，具有不典型特征或旁观者冠状动脉疾病。在这些“灰色”病例中，在疾病的急性期使用T2 STIR和晚期gado linium增强的心脏MRI是非常有帮助的，并且在我们看来，患者应该在临床稳定时转移到心脏MRI可用的中心。需要注意的是，Takotsubo综合征急性期严重急性并发症的发生率很高（肺水肿约15- 20%，心源性休克约10%，恶性室性心律失常2-5%），6-8，只有当临床稳定时，才应考虑对患者进行心脏MRI。我们同意Garg及其同事的意见，即需要进行前瞻性、多中心研究，以阐明心脏MRI在诊断或疑似急性Takotsubo综合征患者的诊断算法中的临床作用。
Alexander R. Lyon and Yoshihiro J. Akashi abnormalities, and normal coronary arteries (or no culprit coronary disease). These bene fits include diagnosis of other pathologies, such as hypertrophic cardiomyo pathy, peri carditis, myocarditis, exclusion of myocar dial infarction in coronary distribution, and evidence of acute oedema or inflam mation in the typical circumferential distribution associated with the Takotsubo syndrome anatomical variants. The increasing number of reports and small series demonstrating increased T2STIR (Short Tau Inversion Recovery) signal in the dysfunctional seg ments of typical cases of Takotsubo syn drome have also contributed to the body of evidence suggesting that acute stress trig gers acute myocardial inflammation and/or oedema. The biopsy evidence, as discussed in our Review, 2 also supports this hypoth esis. Moreover, cardiac MRI can be used to identify complications associated with acute Takotsubo syndrome, including apical thrombus, right ventricular involvement, pericarditis, and outflow tract obstruction. At a practical level, many cases of Tako tsubo syndrome are easily identifiable on the basis of diagnostic coronary angio graphy, RWMAs on left ventriculography or echo cardiography, electrocardiographic changes, and clinical presentation. In these patients, routine use of cardiac MRI is not essential, but can be used where available. However, many cases are not straight forward, with atypical features or bystander coronary artery disease. In these ‘grey’cases, the use of cardiac MRI with T2STIR and late gado linium enhancement is extremely helpful during the acute phase of the disease and, in our view, patients should be transferred when clinically stable to centres where cardiac MRI is available. One note of caution is the high incidence of serious acute compli cations during the acute phase of Takotsubo syndrome (pulmonary oedema~ 15–20%, cardiogenic shock~ 10%, malignant ven tricular arrhythmias 2–5%), 6–8 and patients should be considered for cardiac MRI only when clinically stable. We agree with Garg and colleagues’ comment regarding the need for prospective, multicentre studies to clarify the clinical role of cardiac MRI in the diag nostic algorithm for patients with diagnosed or suspected acute Takotsubo syndrome.