Facciorusso Antonio, Vigna Carlo, Amico Cesare, Lanna Pompeo, Troiano Giovanni, Stanislao Mario, Valle Guido, Santoro Tiberio, Fanelli Raffaele
Int J Cardiol. 2009 May 15;134(2):255-9. doi: 10.1016/j.ijcard.2007.12.104. Epub 2008 Apr 14.
The Tako-Tsubo Syndrome is a clinical entity characterized by acute but rapidly reversible left ventricular systolic dysfunction and triggered by emotional or psychological stress. The aim of our study was to determine the prevalence and characteristics of this syndrome among the patients presenting to our Centre with suspicion of acute coronary syndrome.
Over a 12-month period (May 2006 to April 2007), among 82 patients referred to our catheterization laboratory with suspicion of acute coronary syndrome, 4 confirmed Tako-Tsubo Syndrome (prevalence 4.87%). The patients referred to our Centre came from Foggia's province above all. The mean age of the population was 65.5 +/- 18.48 years (range 49 to 82), with a ratio of men to women of 1:3. The syndrome characterized by acute chest pain with ST-segment elevation, absence of significant lesions in each of the 3 epicardial coronary arteries by angiography, systolic dysfunction (ejection fraction 35 +/- 9.12%) with abnormal wall motion of the mid and distal LV and hyperkinesia of the basal LV, and emotional or psychological stress immediately preceding the cardiac events. Among markers of cardiac necrosis, only serum Troponin-I increased in each patients without significant elevation of CPK and with mild elevation of CK-mb and LDH. 2 patients developed hemodynamic instability. Each patient survived with normalized ejection fraction (54.25 +/- 5.05%) and rapid restoration to previous functional cardiovascular status within 4 weeks.
A reversible cardiomyopathy triggered by emotional or psychological stress occurs in elderly women above all and mimic acute coronary syndrome. The diagnosis of Tako-Tsubo Syndrome is based mainly on coronary and left ventricular angiography, which excludes the diagnosis of coronary artery disease and recognizes the pattern of wall-motion abnormalities. The different epidemiology of this Syndrome reported in literature demonstrates which this cardiomyopathy is underdiagnosed.
应激性心肌病是一种临床病症，其特征为急性但可迅速逆转的左心室收缩功能障碍，由情绪或心理应激引发。我们研究的目的是确定在我院疑似急性冠脉综合征的患者中该综合征的患病率及特征。
在12个月期间（2006年5月至2007年4月），在我院导管室转诊的82例疑似急性冠脉综合征患者中，4例确诊为应激性心肌病（患病率4.87%）。转诊至我院的患者主要来自福贾省。患者平均年龄为65.5±18.48岁（范围49至82岁），男女比例为1:3。该综合征的特征为急性胸痛伴ST段抬高，血管造影显示三支心外膜冠状动脉均无明显病变，收缩功能障碍（射血分数35±9.12%），左心室中、远端壁运动异常，左心室基底段运动亢进，且心脏事件发生前有情绪或心理应激。在心肌坏死标志物中，仅血清肌钙蛋白I在每位患者中升高，肌酸磷酸激酶无明显升高，肌酸激酶同工酶和乳酸脱氢酶轻度升高。2例患者出现血流动力学不稳定。每位患者均存活，射血分数恢复正常（54.25±5.05%），并在4周内迅速恢复至先前的心血管功能状态。
由情绪或心理应激引发的可逆性心肌病主要发生在老年女性中，可模拟急性冠脉综合征。应激性心肌病的诊断主要基于冠状动脉和左心室血管造影，排除冠状动脉疾病的诊断并识别壁运动异常模式。文献报道的该综合征不同的流行病学情况表明这种心肌病存在诊断不足的情况。
