Tsuchihashi K, Ueshima K, Uchida T, Oh-mura N, Kimura K, Owa M, Yoshiyama M, Miyazaki S, Haze K, Ogawa H, Honda T, Hase M, Kai R, Morii I
Second Department of Internal Medicine, Sapporo Medical University School of Medicine, Japan.
J Am Coll Cardiol. 2001 Jul;38(1):11-8. doi: 10.1016/s0735-1097(01)01316-x.
To determine the clinical features of a novel heart syndrome with transient left ventricular (LV) apical ballooning, but without coronary artery stenosis, that mimics acute myocardial infarction, we performed a multicenter retrospective enrollment study.
Only several case presentations have been reported with regard to this syndrome.
We analyzed 88 patients (12 men and 76 women), aged 67 +/- 13 years, who fulfilled the following criteria: 1) transient LV apical ballooning, 2) no significant angiographic stenosis, and 3) no known cardiomyopathies.
Thirt-eight (43%) patients had preceding aggravation of underlying disorders (cerebrovascular accident [n = 3], epilepsy [n = 3], exacerbated bronchial asthma [n = 3], acute abdomen [n = 7]) and noncardiac surgery or medical procedure (n = 11) at the onset. Twenty-four (27%) patients had emotional and physical problems (sudden accident [n = 2], death/funeral of a family member [n = 7], inexperience with exercise [n = 6], quarreling or excessive alcohol consumption [n = 5] and vigorous excitation [n = 4]). Chest symptoms (67%), electrocardiographic changes (ST elevation [90%], Q-wave formation [27%] and T-wave inversion [97%]) and elevated creatine kinase (56%) were found. After treatment of pulmonary edema (22%), cardiogenic shock (15%) and ventricular tachycardia/fibrillation (9%), 85 patients had class I New York Heart Association function on discharge. The LV ejection fraction improved from 41 +/- 11% to 64 +/- 10%. Transient intraventricular pressure gradient and provocative vasospasm were documented in 13/72 (18%) and 10/48 (21%) of the patients, respectively. During follow-up for 13 +/- 14 months, two patients showed recurrence, and one died suddenly.
A novel cardiomyopathy with transient apical ballooning was reported. Emotional or physical stress might play a key role in this cardiomyopathy, but the precise etiologic basis still remains unclear.
为确定一种新型心脏综合征的临床特征，该综合征表现为短暂性左心室心尖部气球样变但无冠状动脉狭窄，类似急性心肌梗死，我们开展了一项多中心回顾性入组研究。
关于该综合征仅报道了几例病例。
我们分析了88例患者（12例男性和76例女性），年龄67±13岁，这些患者符合以下标准：1）短暂性左心室心尖部气球样变；2）血管造影无明显狭窄；3）无已知的心肌病。
38例（43%）患者在发病时有基础疾病加重（脑血管意外[n = 3]、癫痫[n = 3]、支气管哮喘加重[n = 3]、急腹症[n = 7]）以及非心脏手术或医疗操作（n = 11）。24例（27%）患者有情绪和身体方面的问题（突发事故[n = 2]、家庭成员死亡/葬礼[n = 7]、缺乏运动经验[n = 6]、争吵或过量饮酒[n = 5]以及剧烈兴奋[n = 4]）。发现有胸部症状（67%）、心电图改变（ST段抬高[90%]、Q波形成[27%]和T波倒置[97%]）以及肌酸激酶升高（56%）。在治疗肺水肿（22%）、心源性休克（15%）和室性心动过速/心室颤动（9%）后，85例患者出院时纽约心脏协会心功能分级为I级。左心室射血分数从41±11%提高到64±10%。分别在13/72例（18%）和10/48例（21%）患者中记录到短暂性心室内压力梯度和激发性血管痉挛。在13±14个月的随访期间，2例患者复发，1例突然死亡。
报道了一种新型的伴有短暂性心尖部气球样变的心肌病。情绪或身体应激可能在这种心肌病中起关键作用，但确切的病因基础仍不清楚。
