Association of Endocrine Conditions With Takotsubo Cardiomyopathy: A Comprehensive Review.
Association of Endocrine Conditions With Takotsubo Cardiomyopathy: A Comprehensive Review.
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DOI：
10.1161/jaha.118.009003
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发表时间：
2018-10-02
影响因子：
5.4
通讯作者：
Mattana J
中科院分区：
文献类型：
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作者：
Gupta S;Goyal P;Idrees S;Aggarwal S;Bajaj D;Mattana J
Takotsubo心肌病（TCMP），也被称为应激性心肌病或心碎综合征，是一种日益被认可的短暂性左心室（LV）功能障碍，通常是完全可逆的。1-4在最初表现出急性冠状动脉综合征症状的患者中，有1%至2%的患者被诊断为急性冠状动脉综合征。2常表现为呼吸困难、低血压、晕厥、肌钙蛋白升高、心电图ST段抬高或T波倒置。1冠状动脉造影通常显示正常冠状动脉，无明显狭窄，但可能存在旁观者冠状动脉疾病，通常是轻度的，不足以解释心室功能障碍的程度。1，2并发症可在病程早期发生，包括心律失常、血栓形成、LV出口道梗阻、心室破裂、心源性休克和心脏骤停。1，3据报道，死亡率高达8%，恢复良好，95%。[3]经典的描述是在身体和情绪事件之后，触发因素的复发率为10%至11%。1已描述了TCMP的几种变体。典型或心尖变异包括左心室基底运动亢进伴局灶性心尖运动不能，导致心尖气球样变和射血分数降低。其他变异如倒置或基底型（环周基底运动减退和心尖部收缩过度）、左心室中部变异（环周心室中部运动减退和基底部和心尖部收缩过度）以及双心室心尖部和右心室型也有描述。1、4
Takotsubo cardiomyopathy (TCMP), also known as stress cardiomyopathy or broken-heart syndrome, is an increasingly recognized form of transient left ventricular (LV) dysfunction that is often completely reversible. 1–4 It is diagnosed in 1% to 2% of patients initially presenting with symptoms suggestive of acute coronary syndrome. 2 It often presents with dyspnea, hypotension, syncope, elevated troponin levels, and ST elevations or T wave inversions on electrocardiography. 1 Coronary angiography classically reveals normal coronary arteries with no significant stenosis, though bystander coronary disease could be present, which is often mild and not severe enough to account for the degree of ventricular dysfunction. 1, 2 Complications can occur early in its course and include arrhythmia, thrombus formation, LV outlet tract obstruction, ventricular rupture, cardiogenic shock, and cardiac arrest. 1, 3 An up to 8% mortality rate has been reported with excellent recovery in 95%. 3 Classically it has been described following a physical and emotional event, with recurrence rates of 10% to 11% on revival of triggering factors. 1Several variants of TCMP have been described. The typical or apical variant consists of a hyperkinetic LV base with focal apical akinesis resulting in apical ballooning and reduced ejection fraction. Other variants such as the inverted or basal pattern (circumferential basal hypokinesis and apical hypercontractility), the mid LV variant (circumferential midventricular hypokinesis and both basal and apical hypercontractility), and the biventricular apical and right ventricular pattern have been described. 1, 4