Division of Cardiology, Warren Alpert Medical School of Brown University, Providence, Rhode Island, USA.
Am J Cardiol. 2011 Sep 15;108(6):888-91. doi: 10.1016/j.amjcard.2011.05.012. Epub 2011 Jul 7.
The precise cause of takotsubo cardiomyopathy (TC) remains controversial. Plaque rupture with transient thrombotic occlusion of a transapical left anterior descending coronary artery (LAD) has been advanced as a potential mechanism. To explore this hypothesis, the investigators analyzed data from 11 patients prospectively enrolled in the Rhode Island Takotsubo Cardiomyopathy Registry who underwent coronary angiography and intravascular ultrasound evaluation of the LAD during their initial presentation. Despite the presence of nonobstructive coronary artery disease, no culprit lesion was identified in any patient. Similarly, the course of the LAD failed to account for the characteristic left ventricular apical ballooning seen in TC. In conclusion, an atherosclerotic coronary lesion in the LAD causing an aborted myocardial infarction may not be the primary underlying cause of TC, and nonobstructive coronary artery disease and TC may coexist without a direct causal association.
导致心尖球形综合征（TC）的确切原因仍存在争议。斑块破裂伴一过性左前降支（LAD）心尖部血栓性闭塞已被提出作为潜在的发病机制。为了探索这一假说，研究人员分析了罗得岛 TC 注册研究中 11 例前瞻性纳入的患者的数据，这些患者在初次就诊时接受了 LAD 的冠状动脉造影和血管内超声检查。尽管存在非阻塞性冠状动脉疾病，但在任何患者中均未发现罪犯病变。同样，LAD 的病变过程也不能解释 TC 中所见的典型左心室心尖球囊样扩张。总之，导致心肌梗死中止的 LAD 粥样硬化性冠状动脉病变可能不是 TC 的主要潜在原因，非阻塞性冠状动脉疾病和 TC 可能共存而无直接因果关系。
