Cardiology Division, Umberto I Hospital, Mestre-Venice, Italy.
Ann Med. 2009;41(6):462-70. doi: 10.1080/07853890903022793.
The aim of the study was to assess coronary flow reserve (CFR) in tako-tsubo cardiomyopathy (TC).
Thirty consecutive patients (5 males; age 68+/-12 years) meeting diagnostic criteria for TC were evaluated with transthoracic dipyridamole (0.84 mg/kg over 6 min) stress echo and pulsed Doppler CFR assessment on mid-distal left anterior descending (LAD) and posterior descending of right coronary artery (PD). Wall motion score index (WMSI) was evaluated at base-line and during stress. All patients were followed up clinically and-on day 1, day 7 (+/-2 days), and at 6 months-by repeat stress echo. Thirty gender- matched controls were also studied. CFR was obtained in all patients on LAD and in 25 on PD. All showed a transient apical ballooning in the acute phase (day 1 of admission), with progressive recovery of function at follow-up (WMSI, day 1 = 1.7+/-0.2; day 7 = 1.4+/-0.14; 6 months = 1.0+/-0.1; P<0.001 versus day 1 and versus day 7). When compared to controls (3.1+/-0.5), CFR on LAD was reduced on day 1 (1.8+/-0.24, P<0.001) (upon admission), and it showed early recovery in the subacute (pre-discharge) assessment on day 7. CFR values remained stable at 6-month follow-up (2.6+/-0.3).
TC is characterized by a profound, diffuse coronary microcirculatory disturbance in the acute phase, with early reversal to near-normal values within a few days, paralleling the functional recovery in regional wall motion.
评估心尖球囊样综合征（TC）患者的冠状动脉血流储备（CFR）。
连续入选 30 例符合 TC 诊断标准的患者（男 5 例；年龄 68±12 岁），进行经胸多巴酚丁胺（0.84mg/kg，6min）负荷超声心动图和脉冲多普勒 CFR 评估，评估左前降支（LAD）中段和右冠状动脉（PD）中远段的 CFR。在基础状态和应激状态下评估壁运动评分指数（WMSI）。所有患者均接受临床随访，在入院第 1 天、第 7 天（±2 天）和第 6 个月进行重复负荷超声心动图检查。还纳入 30 名性别匹配的对照组。所有患者的 LAD 均获得了 CFR，25 例患者的 PD 获得了 CFR。所有患者在急性期（入院第 1 天）均表现为心尖部球囊样改变，随着随访期心功能逐渐恢复（WMSI，第 1 天=1.7±0.2；第 7 天=1.4±0.14；第 6 个月=1.0±0.1；P<0.001，与第 1 天和第 7 天比较）。与对照组（3.1±0.5）相比，LAD 的 CFR 在入院第 1 天（1.8±0.24，P<0.001）时降低，在亚急性期（出院前）第 7 天评估时恢复较快。CFR 值在第 6 个月随访时保持稳定（2.6±0.3）。
TC 急性期表现为广泛而深刻的冠状动脉微循环障碍，在数天内迅速恢复接近正常，与局部壁运动功能恢复相一致。
