Takotsubo Cardiomyopathy Following Acute Cerebral Events
Takotsubo Cardiomyopathy Following Acute Cerebral Events
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DOI：
10.1159/000440717
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发表时间：
2015-01-01
影响因子：
2.4
通讯作者：
Bejot, Yannick
中科院分区：
文献类型：
--
作者：
Blanc, Christelle;Zeller, Marianne;Bejot, Yannick
目的：Takotsubo心肌病（TCM）是一种以急性应激引起的短暂性心尖室功能不全为特征的心肌病。包括缺血性中风（IS）或癫痫事件（EE）在内的急性脑事件可能与大量儿茶酚胺释放有关。我们的目的是确定谁经历了Takotsubo综合征并发IS或EE. Methods的患者的特点和结果：在2008年和2013年之间，87例患者入住我们的重症监护病房中医。其中，6例患者在IS或EE后2天内曾出现急性脑症状。Takotsubo综合征的诊断依据为心脏MRI、超声心动图、心电图（ECG）、生物学和冠状动脉造影数据。结果：研究纳入了5名女性和1名男性。平均年龄为63.7 ± 20.1岁（范围44-84岁）。其中4例（67%）最初表现为急性IS，2例（33%）有EE。4例患者的疑似脑损伤位于岛叶皮质，2例患者位于后颅窝。偏瘫、失语和小脑症状是主要的神经系统体征。在IS或EE发作后数小时至48小时内出现异常ECG结果，包括ST段抬高（33%）或T波倒置（50%）。肌钙蛋白峰值为1.8（0.79-14.11）μ g/l。使用超声心动图发现左心室射血分数（46 +/- 12%）短暂降低，伴心尖部运动减退。两名（33%）患者继续发展为急性心力衰竭。冠状动脉造影证实所有6例患者均无明显冠状动脉狭窄。结论：急性脑卒中后的几天内，中医药可以发挥作用。它主要发生在岛状或后颅窝病变的女性，可能是由植物反应引起的。(C)2015 S. Karger AG，巴塞尔
Objective: Takotsubo cardiomyopathy (TCM) is characterized by transient apical ventricular dysfunction typically induced by acute stress. Acute cerebral events including ischemic stroke (IS) or epileptic events (EEs) may be associated with massive catecholamine release. We aimed to identify the characteristics and outcomes of patients who experienced the Takotsubo syndrome complicated by IS or EE. Methods: Between 2008 and 2013, 87 patients were admitted to our intensive care unit for TCM. Of these, 6 had previously experienced acute cerebral symptoms within 2 days of experiencing either IS or EE. Takotsubo syndrome was diagnosed on cardiac MRI, echocardiography, electrocardiography (ECG), biology and coronary angiography data. Results: Five women and 1 man were included in the study. The mean age was 63.7 +/- 20.1 years (range 44-84). Four of them (67%) initially presented an acute IS and 2 (33%) had EE. The suspected brain injury was found in the insular cortex for 4 patients and the posterior fossa for 2 patients. Hemiparesis, aphasia and cerebellar symptoms were the main neurological signs. Abnormal ECG findings including ST-segment elevation (33%) or T-wave inversion (50%) developed between a few hours and 48 h after the onset of the IS or EE. Peak troponin was 1.8 (0.79-14.11) mu g/l. A transient reduction in the left ventricular ejection fraction (46 +/- 12%) with apical hypokinesis was found using echocardiography. Two (33%) patients went on to develop acute heart failure. Coronary angiography confirmed the lack of significant coronary stenosis for all 6 patients. Conclusion: TCM can develop within the first few days after an acute cerebral event. It occurs predominantly in women with insular or posterior fossa lesions and is possibly induced by vegetative reactions. (C) 2015 S. Karger AG, Basel