Apical and midventricular transient left ventricular dysfunction syndrome (Tako-Tsubo cardiomyopathy)

被引:396
作者
Kurowski, Volkhard
Kaiser, Axel
von Hof, Katharina
Killermann, Dirk P.
Mayer, Bjoern
Hartmann, Franz
Schunkert, Heribert
Radke, Peter W.
机构
[1] Univ Schleswig Holstein, Med Clin 2, D-23538 Lubeck, Germany
[2] Univ Hosp Schleswig Holstein, Dept Radiol & Nucl Med, Med Clin 2, Lubeck, Germany
关键词
acute myocardial infarction; myocardial stunning; Tako-Tsubo cardiomyopathy; TAKOTSUBO CARDIOMYOPATHY; FEATURES; STRESS; WOMEN;
D O I
10.1378/chest.07-0608
中图分类号
R4 [临床医学];
学科分类号
1002 ; 100602 ;
摘要
Background: The frequency and potential differences between patients with apical ("typical") and midventricular ("atypical") ballooning have not been described. Methods: Consecutive patients with the diagnosis of a troponin-positive acute coronary syndrome (ACS) were prospectively included into a registry (n = 3,265). Of those, 2,944 patients underwent left-heart catheterization and form the study population. Demographic, clinical, and angiographic data including assessment of microvascular dysfunction (Thrombolysis in Myocardial Infarction [TIMI] blush grade, corrected TIMI frame count), as well as clinical outcome were assessed in all patients. Results: In patients with troponin-positive ACS, the frequency of transient cardiomyopathy was 1.2% (35 of 2,944 patients). Typical apical wall motion abnormality was observed in 21 of 35 patients (60%), as compared to an atypical (midventricular) pattern in 14 of 35 patients (40%). Both groups did not differ regarding demographic, clinical, laboratory, or angiographic parameters. Scintigraphy and PET studies were performed in 17 of 35 patients (49%) with transient cardiomyopathy, and showed a strong correlation between location of wall motion abnormality and myocardial metabolism defects, with a significantly higher apical decrease in glucose uptake in patients with a typical pattern. Conclusions: Transient cardiomyopathy affects approximately 1% of patients with a troponin-positive ACS. A typical apical wall motion abnormality is seen in only 60% of patients. Transient cardiomyopathy, also termed Tako-Tsubo cardiomyopathy, therefore should no longer be regarded as an exclusively apical ballooning syndrome, but rather a transient left ventricular dysfunction syndrome with an apical or midventricular pattern of wall motion abnormality.
引用
收藏
页码:809 / 816
页数:8
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