El Mahmoud Rami, Mansencal Nicolas, Pilliére Rémy, Leyer François, Abbou Nacéra, Michaud Pierre, Nallet Olivier, Digne Franck, Lacombe Pascal, Cattan Simon, Dubourg Olivier
Pôle Radio-Cardio-Vasculaire, Université de Versailles-Saint Quentin, Hospital Ambroise Paré, Assistance Publique-Hôpitaux de Paris, Boulogne, France.
Am Heart J. 2008 Sep;156(3):543-8. doi: 10.1016/j.ahj.2008.05.002. Epub 2008 Jul 7.
Tako-Tsubo syndrome is a clinical entity mimicking acute coronary syndrome (ACS). Left ventricular outflow tract (LVOT) obstruction may occur in Tako-Tsubo syndrome. The aim of this study was to determine the prevalence and features of LVOT obstruction in Tako-Tsubo syndrome in a population presenting with ACS.
This study included consecutive patients admitted to 2 catheterization laboratories for suspected ACS. All patients underwent echocardiography, coronary arteriography, and left ventricular angiography if no significant coronary lesions were found.
Among 10,366 patients referred for coronary angiography, the study population consisted of 3,909 patients with suspected ACS. Thirty-two patients (mean age 71 +/- 13 years old) presented with Tako-Tsubo syndrome, resulting in a prevalence of 0.8% in our population of ACS and 5% of patients without significant coronary lesions. Eight women (mean age 81 +/- 4 years old, P = .01) exhibited LVOT obstruction, a prevalence of 25% among Tako-Tsubo syndrome cases. All patients with intraventricular pressure gradient had systolic anterior motion of the mitral valve and septal bulge. Prevalence of septal bulge was 100% in patients with Tako-Tsubo syndrome and LVOT obstruction versus 29% in patients without LVOT obstruction (P = .002). Mean degree of mitral regurgitation was 2.1 +/- 0.7 in cases of LVOT obstruction versus 0.9 +/- 0.7 in patients without LVOT (P = .0003) and significantly decreased during follow-up (1 +/- 0.8, P = .002). Recovery of left ventricular ejection fraction was similar in patients with and without LVOT obstruction (P = .58).
The present study demonstrates that the prevalence of LVOT obstruction in Tako-Tsubo syndrome is high, with specific characteristics as compared with patients without LVOT obstruction. Echocardiography should be systematically performed for all patients presenting with Tako-Tsubo syndrome for the detection of LVOT obstruction.
应激性心肌病是一种酷似急性冠脉综合征（ACS）的临床病症。应激性心肌病可能会发生左心室流出道（LVOT）梗阻。本研究的目的是确定在表现为ACS的人群中，应激性心肌病患者LVOT梗阻的患病率及特征。
本研究纳入了连续入住2个导管室、疑似患有ACS的患者。若未发现明显的冠状动脉病变，所有患者均接受了超声心动图、冠状动脉造影及左心室造影检查。
在10366例接受冠状动脉造影的患者中，研究人群包括3909例疑似ACS患者。32例患者（平均年龄71±13岁）被诊断为应激性心肌病，在我们的ACS患者人群中的患病率为0.8%，在无明显冠状动脉病变的患者中患病率为5%。8名女性（平均年龄81±4岁，P = 0.01）出现LVOT梗阻，在应激性心肌病病例中的患病率为25%。所有存在心室内压力梯度的患者均有二尖瓣收缩期前向运动和室间隔膨出。应激性心肌病合并LVOT梗阻患者的室间隔膨出患病率为100%，而无LVOT梗阻患者的患病率为29%（P = 0.002）。LVOT梗阻患者的平均二尖瓣反流程度为2.1±0.7，无LVOT梗阻患者为0.9±0.7（P = 0.0003），且在随访期间显著降低（1±0.8，P = 0.002）。有LVOT梗阻和无LVOT梗阻患者的左心室射血分数恢复情况相似（P = 0.58）。
本研究表明，应激性心肌病患者中LVOT梗阻的患病率较高，与无LVOT梗阻的患者相比具有特定特征。对于所有表现为应激性心肌病的患者，均应系统地进行超声心动图检查以检测LVOT梗阻。
