Acute and reversible cardiomyopathy provoked by stress in women from the United States
Acute and reversible cardiomyopathy provoked by stress in women from the United States
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DOI：
10.1161/01.cir.0000153801.51470.eb
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发表时间：
2005-02-01
期刊：
影响因子：
37.8
通讯作者：
Maron, BJ
中科院分区：
文献类型：
--
作者：
Sharkey, SW;Lesser, JR;Maron, BJ
背景-急性，但迅速可逆的左心室（LV）收缩功能障碍和引发的心理压力的临床实体正在出现，主要局限于Japanes.Methods和结果的报告-在32个月的时间内，22例连续的这种新型心肌病患者进行了前瞻性确定在明尼阿波利斯-圣保罗，明尼苏达州，地区的社区为基础的做法。所有患者均为女性，年龄为32 - 89岁（平均65 ± 13岁）; 21例（96%）年龄大于或等于50岁。该综合征的特征是：（1）急性胸骨下胸痛伴ST段抬高和/或T波倒置;（2）血管造影无明显冠状动脉狭窄;（3）收缩功能障碍（射血分数29 +/- 9%），左心室中段和远端室壁运动异常，即“心尖气球样变”;和（4）在心脏事件之前和触发心脏事件之前的深刻的心理压力（例如，亲属死亡、家庭虐待、争论、灾难性的医学诊断、毁灭性的经济或赌博损失）。很大比例的患者（37%）存在血流动力学损害，需要血管加压剂和主动脉内球囊反搏。每例患者均存活，射血分数正常化（63 +/- 6%; P < 0.001），并在6 +/- 3天内迅速恢复到先前的功能性心血管状态。在95%，MRI确定弥漫性分布的节段性室壁运动异常，包括LV心肌在多个冠状动脉血管regiments.Conclusions -一个可逆的心肌病引发的心理应激事件发生在老年妇女，可能会模仿不断发展的急性心肌梗死或冠状动脉综合征。这种疾病的特征是收缩功能障碍的独特形式，主要影响远端LV腔室，适当的药物治疗可获得良好的结局。
Background - A clinical entity characterized by acute but rapidly reversible left ventricular (LV) systolic dysfunction and triggered by psychological stress is emerging, with reports largely confined to Japan.Methods and Results - Over a 32-month period, 22 consecutive patients with this novel cardiomyopathy were prospectively identified within a community-based practice in the Minneapolis - St. Paul, Minn, area. All patients were women aged 32 to 89 years old ( mean 65 +/- 13 years); 21 (96%) were greater than or equal to 50 years of age. The syndrome is characterized by ( 1) acute substernal chest pain with ST-segment elevation and/or T-wave inversion; ( 2) absence of significant coronary arterial narrowing by angiography; ( 3) systolic dysfunction ( ejection fraction 29 +/- 9%), with abnormal wall motion of the mid and distal LV, ie, "apical ballooning"; and ( 4) profound psychological stress (eg, death of relatives, domestic abuse, arguments, catastrophic medical diagnoses, devastating financial or gambling losses) immediately preceding and triggering the cardiac events. A significant proportion of patients (37%) had hemodynamic compromise and required vasopressor agents and intra-aortic balloon counterpulsation. Each patient survived with normalized ejection fraction (63 +/- 6%; P < 0.001) and rapid restoration to previous functional cardiovascular status within 6 +/- 3 days. In 95%, MRI identified diffusely distributed segmental wall-motion abnormalities that encompassed LV myocardium in multiple coronary arterial vascular territories.Conclusions - A reversible cardiomyopathy triggered by psychologically stressful events occurs in older women and may mimic evolving acute myocardial infarction or coronary syndrome. This condition is characterized by a distinctive form of systolic dysfunction that predominantly affects the distal LV chamber and a favorable outcome with appropriate medical therapy.