Meimoun Patrick, Malaquin Dorothée, Sayah Smain, Benali Tahar, Luycx-Bore Anne, Levy Franck, Zemir Hamdane, Tribouilloy Christophe
Department of Cardiology and Intensive Care Unit, Compiègne Hospital, Compiègne, France.
J Am Soc Echocardiogr. 2008 Jan;21(1):72-7. doi: 10.1016/j.echo.2007.05.024. Epub 2007 Jul 12.
The clinical features of tako-tsubo cardiomyopathy or transient left apical ballooning syndrome (LABS) have been clearly described, but the mechanisms are still unknown. Our objective was to prospectively assess coronary microcirculation at the acute phase of LABS and after functional recovery, using Doppler transthoracic echocardiography-coronary flow reserve (CFR). Twelve consecutive patients (11 women, mean age 68 +/- 10 years) satisfying the criteria for LABS underwent Doppler transthoracic echocardiography-CFR in the distal part of the left anterior descending coronary artery, using intravenous adenosine infusion (0.14 mg/kg/min over 2 minutes) at the acute phase and 25 +/- 3 days later. CFR was calculated as the ratio of hyperemic to basal mean diastolic flow velocity. Wall-motion score (WMS) was calculated using the 16-segment model during the same echocardiographic examination (normal WMS = 16). Doppler transthoracic echocardiography-CFR increased between the two examinations from 2.2 +/- 0.4 at the acute phase to 2.9 +/- 0.3 (P < .01), whereas WMS decreased (from 31 +/- 6 at the acute phase to 16.5 +/- 0.8, delta WMS = -14.6 +/- 6, P < .01). All patients exhibited an increase of CFR between the two tests (delta CFR = 0.73 +/- 0.39, range: 0.3-1.6). A significant correlation was observed between delta CFR and delta WMS (r = -0.89, P < .01). In conclusion, serial noninvasive CFR measurements performed in LABS suggested transient microcirculatory impairment during the acute phase of the syndrome. The wall-motion improvement parallel to the dynamic improvement of the microcirculation suggests a role of coronary microcirculatory damage in the pathogenesis of acute and transient wall-motion abnormalities in LABS.
应激性心肌病或短暂性左心室心尖气球样变综合征（LABS）的临床特征已得到明确描述，但其发病机制仍不清楚。我们的目的是利用经胸多普勒超声心动图-冠状动脉血流储备（CFR），对LABS急性期和功能恢复后的冠状动脉微循环进行前瞻性评估。连续12例符合LABS标准的患者（11例女性，平均年龄68±10岁），在急性期及25±3天后，经静脉输注腺苷（0.14 mg/kg/min，持续2分钟），对左前降支冠状动脉远端进行经胸多普勒超声心动图-CFR检查。CFR计算为充血期与基础平均舒张期血流速度之比。在同一超声心动图检查期间，采用16节段模型计算室壁运动评分（WMS）（正常WMS = 16）。两次检查之间，经胸多普勒超声心动图-CFR从急性期的2.2±0.4增加到2.9±0.3（P < 0.01），而WMS降低（从急性期的31±6降至16.5±0.8，ΔWMS = -14.6±6，P < 0.01）。所有患者在两次检查之间CFR均增加（ΔCFR = 0.73±0.39，范围：0.3 - 1.6）。观察到ΔCFR与ΔWMS之间存在显著相关性（r = -0.89，P < 0.01）。总之，对LABS进行的系列无创CFR测量表明，该综合征急性期存在短暂的微循环障碍。室壁运动改善与微循环动态改善平行，提示冠状动脉微循环损伤在LABS急性和短暂性室壁运动异常的发病机制中起作用。
