Kuo Bruce T, Choubey Rakesh, Novaro Gian M
Department of Internal Medicine, Cleveland Clinic Florida, Weston, Florida 33331, USA.
Gend Med. 2010 Feb;7(1):71-7. doi: 10.1016/j.genm.2010.01.006.
Takotsubo cardiomyopathy (apical ballooning syndrome) has been reported with increased frequency, most commonly in postmenopausal women. Despite the gender disparity, no clear link between estrogen and its possible cardioprotective effects has been shown.
We present a case series of takotsubo cardiomyopathy in women and examine the prevalence of estrogen replacement therapy (ERT), in addition to conducting a systematic literature review on this topic.
Consecutive cases of takotsubo cardiomyopathy were identified at our institution, Cleveland Clinic Florida, from January 2006 to December 2008, and patient-level data were extracted for analysis. For the literature review, we searched the MEDLINE database from January 1990 to March 2008 for English-language publications, using the terms apical ballooning syndrome, takotsubo, and stress cardiomyopathy, and identified case reports and series of takotsubo cardiomyopathy. Articles describing female patients and their medication use at time of presentation were included in the study.
Eighteen cases of takotsubo cardiomyopathy were identified at our institution, all in postmenopausal women except for 2 who were still menstruating. Of the 16 postmenopausal cases, none were taking ERT at time of presentation. From the literature review, >400 publications were queried, of which 296 were recognized as case reports or series, with 7 articles meeting all of our inclusion criteria. From these reports, 13 women were identified, none of whom were taking ERT at time of presentation.
Lack of estrogen replacement in the postmenopausal state may predispose women to takotsubo cardiomyopathy. Further studies are needed to establish the link more firmly.
应激性心肌病（心尖球囊样综合征）的报道频率有所增加，最常见于绝经后女性。尽管存在性别差异，但雌激素与其可能的心脏保护作用之间尚未显示出明确的联系。
我们展示一组女性应激性心肌病病例系列，并研究雌激素替代疗法（ERT）的患病率，此外还对该主题进行系统的文献综述。
2006年1月至2008年12月在我们位于佛罗里达州克利夫兰诊所的机构中确定了应激性心肌病的连续病例，并提取患者层面的数据进行分析。对于文献综述，我们在1990年1月至2008年3月期间搜索MEDLINE数据库以查找英文出版物，使用术语心尖球囊样综合征、应激性心肌病和应激性心肌病，并确定应激性心肌病的病例报告和系列。描述女性患者及其就诊时用药情况的文章纳入研究。
我们机构确定了18例应激性心肌病病例，除2例仍在月经的患者外，均为绝经后女性。在16例绝经后病例中，就诊时无人使用ERT。从文献综述中，查询了400多篇出版物，其中296篇被确认为病例报告或系列，7篇文章符合我们所有的纳入标准。从这些报告中，确定了13名女性，她们在就诊时均未使用ERT。
绝经后缺乏雌激素替代可能使女性易患应激性心肌病。需要进一步研究以更牢固地建立这种联系。
