Kurisu Satoshi, Sato Hikaru, Kawagoe Takuji, Ishihara Masaharu, Shimatani Yuji, Nishioka Kenji, Kono Yasuyuki, Umemura Takashi, Nakamura Suji
Division of Cardiology, Hiroshima City Hospital, Hiroshima, Japan.
Am Heart J. 2002 Mar;143(3):448-55. doi: 10.1067/mhj.2002.120403.
Peculiar asynergy, which consists of hypokinesis or akinesis from the mid portion to the apical area and hyperkinesis of the basal area on contrast left ventriculogram, is rare. Because the end-systolic left ventriculogram looks like a "tako-tsubo," which was used for trapping octopuses in Japan, we proposed the term "tako-tsubo-like left ventricular dysfunction." Our aim was to evaluate its clinical features and causes.
We studied 30 patients with tako-tsubo-like left ventricular dysfunction without significant coronary artery disease. We assessed its pathophysiologic mechanisms by coronary spasm provocation test, endomyocardial biopsy, measurement of virus titer, and measurement of circulating catecholamine levels.
Patient age ranged from 55 to 83 years. Twenty-eight were women and 2 were men. Tako-tsubo-like left ventricular dysfunction was dramatically resolved on predischarge left ventriculogram at 11.3 +/- 4.3 days. Acute coronary angiography revealed spontaneous multivessel coronary spasm in 3 patients. Among 14 patients, ergonovine or acetylcholine induced epicardial single coronary spasm in 4 patients and multivessel coronary spasm in 6 patients. Spontaneous microvascular spasm occurred at predischarge in 1 patient. An endomyocardial biopsy specimen in 3 patients and measurement of virus titer in 7 patients did not show evidence of acute myocarditis. Circulating norepinephrine was normal or slightly elevated in 6 patients.
We showed clinical features of a novel cardiac syndrome with tako-tsubo-like left ventricular dysfunction. Although the precise cause remains unclear, simultaneous multivessel coronary spasm at the epicardial artery or microvascular levels may contribute to the onset of tako-tsubo-like left ventricular dysfunction.
特殊的运动失调，表现为左心室造影时从心中部到心尖区域运动减弱或运动不能，而基底部运动亢进，这种情况很罕见。由于收缩末期左心室造影看起来像“章鱼壶”（在日本用于捕捉章鱼），我们提出了“章鱼壶样左心室功能障碍”这一术语。我们的目的是评估其临床特征和病因。
我们研究了30例无明显冠状动脉疾病的章鱼壶样左心室功能障碍患者。我们通过冠状动脉痉挛激发试验、心内膜活检、病毒滴度测量和循环儿茶酚胺水平测量来评估其病理生理机制。
患者年龄在55至83岁之间。28例为女性，2例为男性。章鱼壶样左心室功能障碍在出院前左心室造影时于11.3±4.3天显著缓解。急性冠状动脉造影显示3例患者出现自发性多支冠状动脉痉挛。在14例患者中，麦角新碱或乙酰胆碱诱发4例患者出现心外膜单支冠状动脉痉挛，6例患者出现多支冠状动脉痉挛。1例患者在出院前出现自发性微血管痉挛。3例患者的心内膜活检标本和7例患者的病毒滴度测量均未显示急性心肌炎的证据。6例患者的循环去甲肾上腺素正常或略有升高。
我们展示了一种具有章鱼壶样左心室功能障碍的新型心脏综合征的临床特征。虽然确切病因尚不清楚，但心外膜动脉或微血管水平的同时多支冠状动脉痉挛可能导致章鱼壶样左心室功能障碍的发生。
