Standard and Advanced Echocardiography in Takotsubo (Stress) Cardiomyopathy: Clinical and Prognostic Implications
Standard and Advanced Echocardiography in Takotsubo (Stress) Cardiomyopathy: Clinical and Prognostic Implications
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DOI：
10.1016/j.echo.2014.08.020
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发表时间：
2015-01-01
影响因子：
6.5
通讯作者：
Bossone, Eduardo
中科院分区：
文献类型：
--
作者：
Citro, Rodolfo;Lyon, Alexander R.;Bossone, Eduardo
超声心动图通常是最初的非侵入性成像方式，用于评估患有takotsubo心肌病（TTC）的患者。标准经胸超声心动图即使在急性护理环境中也可以提供关于左心室（LV）形态以及局部和整体收缩或舒张功能的有用信息。它允许根据室壁运动异常的定位来区分不同的LV形态学模式。左室心肌功能不全的“环形模式”，其特征是涉及前壁、下壁和侧壁的心室中段的对称性室壁运动异常，应被视为TTC的提示，并纳入急性冠状动脉综合征的鉴别诊断。此外，先进的超声心动图技术，包括斑点追踪，心肌对比，冠状动脉血流研究，提供了机制和病理生理的见解，这种独特的综合征。早期识别任何潜在并发症（即，LV流出道梗阻、可逆性中度至重度二尖瓣返流、右心室受累、血栓形成和心脏破裂）对于TTC患者的管理、风险分层和随访至关重要。由于该综合征的动态演变，应系统地进行全面的系列超声心动图检查。本文综述了这些方面的成像和越来越多的了解的临床和预后效用超声心动图在TTC。
Echocardiography is frequently the initial noninvasive imaging modality used to assess patients with takotsubo cardiomyopathy (TTC). Standard transthoracic echocardiography can provide, even in the acute care setting, useful information about left ventricular (LV) morphology as well as regional and global systolic or diastolic function. It allows the differentiation of different LV morphologic patterns according to the localization of wall motion abnormalities. A "circumferential pattern'' of LV myocardial dysfunction characterized by symmetric wall motion abnormalities involving the midventricular segments of the anterior, inferior, and lateral walls should be considered suggestive of TTC and included in the differential diagnosis of acute coronary syndromes. Moreover, advanced echocardiographic techniques, including speckle-tracking, myocardial contrast, and coronary flow studies, are providing mechanistic and pathophysiologic insights into this unique syndrome. Early identification of any potential complications (i.e., LV outflow tract obstruction, reversible moderate to severe mitral regurgitation, right ventricular involvement, thrombus formation, and cardiac rupture) are crucial for the management, risk stratification, and follow-up of patients with TTC. Because of the dynamic evolution of the syndrome, comprehensive serial echocardiographic examinations should be systematically performed. This review focuses on these aspects of imaging and the increasing understanding of the clinical and prognostic utility of echocardiography in TTC.