I. Medical Department, University Hospital Mannheim, Mannheim, 68167 Germany.
Clin Res Cardiol. 2010 Feb;99(2):93-8. doi: 10.1007/s00392-009-0078-1. Epub 2009 Sep 23.
In a previous report, acute mitral regurgitation (MR) was found to indicate the more severe end of the spectrum of Takotsubo cardiomyopathy (TC). The aim of this study was to determine the incidence and clinical significance of acute MR in TC.
Early (<24 h of presentation) left ventricular (LV) angiograms of 47 patients with TC were reviewed by two blinded reviewers. MR severity was graded on a four graded scale. MR > or = grade 2 was considered significant.
Significant MR was present in nine (19%) patients. MR was severe (grade 3 or 4) in four and moderate (grade 2) in five. LV outflow tract gradients were not observed in any of these patients. Patients with and without significant MR did not differ with regard to various clinical parameters, including age, gender, type of TC, cardiovascular risk factors, presenting ECG, level of troponin I, triggering factors, ejection fraction (EF), vasopressor therapy, pulmonary edema, and survival to discharge. When patients were grouped according to the presence or absence of pulmonary edema, the only significant difference between the two groups was EF which was significantly lower in patients with pulmonary edema (40 +/- 12% vs. 50 +/- 12%, P = 0.011).
Acute MR is a noteworthy finding in TC, but it is not associated with the severity of TC. Dysfunction of mid-ventricular myocardium seems to be a conditio sine qua non, whereas LVOT obstruction does not seem to play an important role.
在之前的一份报告中，急性二尖瓣反流（MR）被认为是 Takotsubo 心肌病（TC）谱中更严重的一端。本研究旨在确定 TC 中急性 MR 的发生率和临床意义。
回顾了 47 例 TC 患者的早期（<24 小时就诊时）左心室（LV）造影，由两名盲法评审员进行。MR 严重程度分为四级。MR >或= 2 级被认为是显著的。
9 例（19%）患者存在显著 MR。4 例为严重（3 或 4 级），5 例为中度（2 级）。这些患者中均未观察到 LV 流出道梯度。有和无显著 MR 的患者在各种临床参数方面没有差异，包括年龄、性别、TC 类型、心血管危险因素、就诊时心电图、肌钙蛋白 I 水平、触发因素、射血分数（EF）、血管加压素治疗、肺水肿和存活至出院。当根据是否存在肺水肿将患者分组时，两组之间唯一的显著差异是 EF，肺水肿患者的 EF 明显更低（40 +/- 12% vs. 50 +/- 12%，P = 0.011）。
急性 MR 在 TC 中是一个值得注意的发现，但它与 TC 的严重程度无关。中心室心肌功能障碍似乎是一个必要条件，而 LVOT 梗阻似乎没有起到重要作用。
