Sganzerla Paolo, Alioto Giusy, Funaro Alfonso, Passaretti Bruno, Borghini Elena, Guglielmetto Silvia
Division of Cardiology, Humanitas Gavazzeni, Bergamo, Italy.
J Cardiovasc Med (Hagerstown). 2008 Dec;9(12):1229-34. doi: 10.2459/JCM.0b013e328313e890.
The aim of this study was to elucidate the role of coronary microvascular function in the pathophysiological scenario of Takotsubo cardiomyopathy.
Noninvasive evaluations of coronary flow reserve through transthoracic Doppler ultrasound imaging of the left anterior descending coronary artery, a reliable marker of coronary microcirculation performance in the absence of epicardial coronary artery stenosis, were performed both in the acute and recovery phases of Takotsubo cardiomyopathy in consecutive patients strictly selected on the basis of absence of risk factors, concomitant diseases, or both impairing coronary microvascular function.
Resting and hyperemic diastolic flow velocity tracings and corresponding velocity time integrals were obtained in seven consecutive patients, six of them women, aged 65-86 years (76 +/- 6.5) at admission and 23 +/- 4 days after, when left ventricular wall motion alterations recovered. In addiction, thrombolysis in myocardial infarction frame count of the two branches of the left coronary artery was evaluated on the cineangiogram obtained at admission. It was normal in both branches of the left coronary artery (left anterior descending, 30.6 +/- 8.79; circumflex, 23.4 +/- 2.96). In each patient, coronary flow reserve, calculated both on velocity time integrals (2.6 +/- 0.2) and average peak diastolic blood flow velocity (2.48 +/- 0.1) values, was in the normal range (>2.0) and did not significantly change when reevaluated in the recovery phase (2.55 +/- 0.1, 2.44 +/- 0.1).
These data suggest that coronary microvascular function may not be impaired in Takotsubo patients when negative influences on coronary flow reserve by concomitant diseases and coronary risk factors are excluded. Its noninvasive evaluation with transthoracic Doppler ultrasound of the distal left anterior descending appears simple and useful in this type of patients.
本研究旨在阐明冠状动脉微血管功能在应激性心肌病病理生理过程中的作用。
在连续入选的、严格排除危险因素及并存疾病（或两者均排除）以免影响冠状动脉微血管功能的应激性心肌病患者中，于急性期和恢复期通过经胸多普勒超声心动图对左前降支冠状动脉进行成像，以此对冠状动脉血流储备进行无创评估，这是在无冠状动脉狭窄情况下冠状动脉微循环功能的可靠指标。
连续7例患者获得静息及充血状态下的舒张期血流速度描记图以及相应的速度时间积分，其中6例为女性，入院时年龄65 - 86岁（76±6.5岁），左心室壁运动异常恢复后23±4天。此外，在入院时获得的冠状动脉造影图像上评估左冠状动脉两个分支的心肌梗死溶栓帧数。左冠状动脉两个分支均正常（左前降支，30.6±8.79；回旋支，23.4±2.96）。在每位患者中，基于速度时间积分（2.6±0.2）和平均舒张期峰值血流速度（2.48±0.1）计算的冠状动脉血流储备均在正常范围内（>2.0），在恢复期重新评估时无显著变化（2.55±0.1，2.44±0.1）。
这些数据表明，在排除并存疾病和冠状动脉危险因素对冠状动脉血流储备的负面影响后，应激性心肌病患者的冠状动脉微血管功能可能未受损。对于这类患者，采用经胸多普勒超声对左前降支远端进行无创评估显得简单且有用。
