Yoshioka Takuji, Hashimoto Akiyoshi, Tsuchihashi Kazufumi, Nagao Kazuhiko, Kyuma Michifumi, Ooiwa Hitoshi, Nozawa Akihiko, Shimoshige Shinya, Eguchi Mariko, Wakabayashi Takeru, Yuda Satoshi, Hase Mamoru, Nakata Tomoaki, Shimamoto Kazuaki
Second Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
Am Heart J. 2008 Mar;155(3):526.e1-7. doi: 10.1016/j.ahj.2007.10.042. Epub 2008 Jan 18.
Persistent hypotension with dynamic midventricular obstruction (MVO) in patients with transient left ventricular (LV) apical ballooning (Tako-tsubo cardiomyopathy) is an important complication that needs to be treated.
The objective of this study is to determine the effects of intravenous propranolol challenge on MVO in transient LV apical ballooning.
Thirty-four patients (12 males, 22 females, mean age 64 +/- 17 years, age range 22-84 years) with LV apical ballooning were enrolled. The hemodynamic and echocardiographic effects of propranolol (0.05 mg/kg, maximum 4 mg) were analyzed in 13 patients.
(1) Midventricular obstruction was present in 8 (24%) of 34 patients, and the pressure gradient (PG) ranged from 28 to 140 mm Hg. (2) Patients with MVO had similar demographic and clinical characteristics (symptoms, peak creatine kinase, plasma catecholamine levels) as those without MVO; however, in patients with MVO, abnormal Q waves on electrocardiogram and hypotension were more prevalent. (3) In the MVO group, intravenous propranolol changed the PG from 90 +/- 42 to 22 +/- 9 mm Hg, the systolic blood pressure (SBP) from 85 +/- 11 to 116 +/- 20 mm Hg, and the LV ejection fraction (LVEF) from 30% +/- 7% to 43% +/- 4%. (4) In all subjects, the changes in the PG after propranolol injection had a significant linear correlation with the SBP and LVEF changes: deltaSBP = 4.738 + 0.315 x deltaPG (r = 0.689 (P < .001) and deltaLVEF = 2.973 + 0.1321 x deltaPG (r = 0.715, P < .001).
Intravenous propranolol is useful for treating dynamic MVO in patients with transient LV apical ballooning.
短暂性左心室心尖气球样变（应激性心肌病）患者出现持续性低血压并伴有动态性心室中部梗阻（MVO）是一种需要治疗的重要并发症。
本研究的目的是确定静脉注射普萘洛尔激发试验对短暂性左心室心尖气球样变患者MVO的影响。
纳入34例左心室心尖气球样变患者（男性12例，女性22例，平均年龄64±17岁，年龄范围22 - 84岁）。分析了13例患者使用普萘洛尔（0.05 mg/kg，最大剂量4 mg）后的血流动力学和超声心动图效应。
（1）34例患者中有8例（24%）存在心室中部梗阻，压力阶差（PG）范围为28至140 mmHg。（2）伴有MVO的患者与不伴有MVO的患者在人口统计学和临床特征（症状、肌酸激酶峰值、血浆儿茶酚胺水平）方面相似；然而，伴有MVO的患者心电图异常Q波和低血压更为常见。（3）在MVO组中，静脉注射普萘洛尔使PG从90±42 mmHg降至22±9 mmHg，收缩压（SBP）从85±11 mmHg升至116±20 mmHg，左心室射血分数（LVEF）从30%±7%升至43%±4%。（4）在所有受试者中，注射普萘洛尔后PG的变化与SBP和LVEF的变化具有显著的线性相关性：ΔSBP = 4.738 + 0.315×ΔPG（r = 0.689，P <.001），ΔLVEF = 2.973 + 0.1321×ΔPG（r = 0.715，P <.001）。
静脉注射普萘洛尔可有效治疗短暂性左心室心尖气球样变患者的动态MVO。
