Hypertrophic Cardiomyopathy Center and Cardiovascular Research Division, Minneapolis Heart Institute Foundation, Minneapolis, Minnesota 55407, USA.
J Am Coll Cardiol. 2010 Jan 26;55(4):333-41. doi: 10.1016/j.jacc.2009.08.057.
This study was designed to define more completely the clinical spectrum and consequences of stress cardiomyopathy (SC) beyond the acute event.
Stress cardiomyopathy is a recently recognized condition characterized by transient cardiac dysfunction with ventricular ballooning.
Clinical profile and outcome were prospectively assessed in 136 consecutive SC patients.
Patients were predominantly women (n = 130; 96%), but 6 were men (4%). Ages were 32 to 94 years (mean age 68 +/- 13 years); 13 (10%) were <or=50 years of age. In 121 patients (89%), SC was precipitated by intensely stressful emotional (n = 64) or physical (n = 57) events, including 22 associated with sympathomimetic drugs or medical/surgical procedures; 15 other patients (11%) had no evident stress trigger. Twenty-five patients (18%) were taking beta-blockers at the time of SC events. Three diverse ventricular contraction patterns were defined by cardiovascular magnetic resonance (CMR) imaging, usually with rapid return to normal systolic function, although delayed >2 months in 5%. Right and/or left ventricular thrombi were identified in 5 patients (predominantly by CMR imaging), including 2 with embolic events. Three patients (2%) died in-hospital and 116 (85%) have survived, including 5% with nonfatal recurrent SC events. All-cause mortality during follow-up exceeded a matched general population (p = 0.016) with most deaths occurring in the first year.
In this large SC cohort, the clinical spectrum was heterogeneous with about one-third either male, <or=50 years of age, without a stress trigger, or with in-hospital death, nonfatal recurrence, embolic stroke, or delayed normalization of ejection fraction. Beta-blocking drugs were not absolutely protective and SC was a marker for increased noncardiac mortality. These data support expanded management and surveillance strategies including CMR imaging and consideration for anticoagulation.
本研究旨在更全面地定义应激性心肌病（SC）在急性事件之外的临床谱和后果。
应激性心肌病是一种新近被认识的疾病，其特征为短暂性心室功能障碍伴心室球囊样变。
前瞻性评估了 136 例连续 SC 患者的临床特征和结局。
患者主要为女性（n=130；96%），但有 6 例为男性（4%）。年龄为 32 至 94 岁（平均年龄 68±13 岁）；13 例（10%）年龄≤50 岁。在 121 例（89%）患者中，SC 由强烈的精神（n=64）或躯体应激（n=57）事件诱发，包括 22 例与拟交感神经药物或医疗/手术有关；15 例其他患者（11%）无明显应激触发因素。25 例（18%）在发生 SC 时正在服用β受体阻滞剂。心血管磁共振（CMR）成像定义了 3 种不同的心室收缩模式，通常迅速恢复正常的收缩功能，尽管有 5%的患者延迟超过 2 个月。5 例患者（主要通过 CMR 成像）发现右心室和/或左心室血栓，包括 2 例有栓塞事件。3 例（2%）患者住院期间死亡，116 例（85%）存活，其中 5%发生非致命性复发性 SC 事件。随访期间全因死亡率超过匹配的一般人群（p=0.016），大多数死亡发生在第一年。
在本大规模 SC 队列中，临床谱呈异质性，约三分之一为男性、≤50 岁、无应激触发因素、或住院期间死亡、非致命性复发、栓塞性脑卒中或射血分数延迟正常。β受体阻滞剂并非绝对保护因素，SC 是心脏外死亡率增加的标志物。这些数据支持扩大管理和监测策略，包括 CMR 成像和考虑抗凝治疗。
