Meimoun Patrick, Malaquin Dorothée, Benali Tahar, Boulanger Jacques, Zemir Hamdane, Tribouilloy Christophe
Department of Cardiology and Intensive Care Unit, Compiègne Hospital, 8 rue Henri Adnot, 60200 Compiègne, France.
Eur J Echocardiogr. 2009 Mar;10(2):265-70. doi: 10.1093/ejechocard/jen222. Epub 2008 Aug 27.
Recent studies suggest that coronary flow reserve (CFR) is transiently impaired in tako-tsubo cardiomyopathy (TTC). Mechanisms by which such impairment occurs are still unknown. To assess the relationship between CFR obtained by transthoracic Doppler echocardiography (TDE) and parameters of left ventricular (LV) performance in patients with TTC.
A total of 20 consecutive patients in sinus rhythm, with TTC (mean age 70+/-9 years, 19 women) underwent serial evaluation of TDE-CFR, in the distal part of the left anterior descending coronary artery (LAD), at the acute phase and after recovery using intravenous adenosine infusion (140 microg/kg/min over 2 min). CFR was calculated as hyperaemic to basal mean diastolic coronary flow velocity (CFV). Average of the septal and lateral mitral annulus early diastolic (Ea) and systolic (Sa) tissue velocity, early (E) and late (A) diastolic transmitral velocity, the ratio E/Ea, wall motion score (WMS, 16 segment model), LV end-systolic volume index (ESV/m(2)) and LV end-diastolic volume index (EDV/m(2), biplane-Simpson method) were serially measured by TDE. Basal CFV, LV mass index and haemodynamics parameters did not differ between acute phase and recovery, whereas hyperaemic CFV increased significantly after recovery (P<0.01) leading to a greater CFR (2.9+/-0.3 vs. 2.1+/-0.4, P<0.0001). At the acute phase, hyperaemic CFV was significantly correlated to WMS, ESV/m(2), but not to E/Ea, whereas at recovery, hyperaemic CFV was not correlated to LV parameters. The improvement of CFR was closely correlated to the decrease of ESV/m(2), of WMS, but not to diastolic parameters. No significant correlation was found between CFR and E/Ea or LV mass index at each stage.
There is a transient impairment of CFR at the acute phase of TTC, which is due to a reduced vasodilating capacity. This impairment is closely correlated to LV systolic parameters. Diastolic compressive forces to the coronary microcirculation do not appear to play a critical role.
近期研究表明，应激性心肌病（TTC）患者的冠状动脉血流储备（CFR）会出现短暂受损。这种受损发生的机制尚不清楚。本研究旨在评估经胸多普勒超声心动图（TDE）测得的CFR与TTC患者左心室（LV）功能参数之间的关系。
连续纳入20例窦性心律的TTC患者（平均年龄70±9岁，19例女性），在急性期和恢复后，通过静脉输注腺苷（2分钟内140μg/kg/min），对左前降支冠状动脉（LAD）远端进行TDE-CFR的系列评估。CFR计算为充血期与基础平均舒张期冠状动脉血流速度（CFV）之比。通过TDE连续测量室间隔和二尖瓣环侧壁舒张早期（Ea）和收缩期（Sa）组织速度、舒张早期（E）和晚期（A）二尖瓣跨瓣血流速度、E/Ea比值、壁运动评分（WMS，16节段模型）、左心室收缩末期容积指数（ESV/m²）和左心室舒张末期容积指数（EDV/m²，双平面辛普森法）。急性期和恢复期的基础CFV、左心室质量指数和血流动力学参数无差异，而充血期CFV在恢复后显著增加（P<0.01），导致CFR升高（2.9±0.3对2.1±0.4，P<0.0001）。在急性期，充血期CFV与WMS、ESV/m²显著相关，但与E/Ea无关，而在恢复期，充血期CFV与左心室参数无关。CFR的改善与ESV/m²、WMS的降低密切相关，但与舒张期参数无关。在每个阶段，CFR与E/Ea或左心室质量指数之间均未发现显著相关性。
TTC急性期存在CFR的短暂受损，这是由于血管舒张能力降低所致。这种受损与左心室收缩参数密切相关。对冠状动脉微循环的舒张期压力似乎不起关键作用。
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