Meimoun Patrick, Passos Pricila, Benali Tahar, Boulanger Jacques, Elmkies Frederic, Zemir Hamdane, Clerc Jerome, Luycx-Bore Anne
Department of Cardiology and Intensive Care Unit, Centre Hospitalier de Compiegne, 8 Rue Henri Adnot, 60200 Compiegne, France.
Eur J Echocardiogr. 2011 Dec;12(12):931-9. doi: 10.1093/ejechocard/jer183. Epub 2011 Sep 28.
To assess left ventricular (LV) twist mechanics in patients with Tako-tsubo cardiomyopathy (TTC).
Two-dimensional strain and LV twist by speckle-tracking echocardiography was performed in 17 consecutive patients with typical TTC according to the Mayo clinic criteria [78 ± 8 years, 88% women, and mean left ventricular ejection fraction (LVEF) 45 ± 10%], at the acute phase (within 24 h after admission) and after recovery (1 month later). Seventeen control (C) patients matched for age and sex (mean LVEF 70 ± 7%), and 17 patients with acute anterior myocardial infarction (MI) treated by successful primary angioplasty 24 h before, matched for LVEF, age, and sex, were compared with TTC patients. LV twist was assessed using the parasternal basal and apical short-axis planes, and defined as the net difference in degrees of apical (Ar) and basal rotation (Br). Peak systolic and early diastolic, apical (As and Ad) and basal (Bs and Bd) rotation rate, and LV twisting rate (TR) and untwisting rate (UR) (in °/s) were derived from rotational and twist curves. The time sequences were normalized to the percentage of systolic duration. At the acute phase, Ar, As, Ad, Bs, LV twist (10 ± 9° vs. 23 ± 6°), LV TR, and LV UR were significantly impaired in patients with TTC when compared with controls (all, P < 0.05). Patients with MI displayed intermediate values (P = NS vs. TTC, and P < 0.05 vs. C). However, in the subgroup of patients with electrocardiogram ST-segment elevation at presentation (n = 12 TTC and 17 MI), several LV twist mechanics parameters were significantly reduced in TTC patients when compared with MI patients, LV twist, and LV TR being the most significant factors (all, P≤ 0.01). Abnormal reversed Ar (clockwise when seen from the apex) was seen in three patients (18%) with TTC vs. none in the other groups. A significant correlation between LV twist and LVEF, LV volumes, wall motion score index, and plasma NT-pro BNP was observed in the TTC group (all, P < 0.05). At follow-up, LV twist mechanics improved significantly in TTC patients (all, P < 0.05 vs. acute phase), who had final values similar to C (all, P = NS), whereas the magnitude of improvement was lower in MI patients (P ≤ 0.05 vs. TTC).
LV twist mechanics is significantly impaired in patients with TTC mainly due to a severe reduction in apical function and is entirely reversible. Furthermore, in the subgroup of patients with ST-segment elevation, the early post-admission evaluation of LV twist mechanics is more severely impaired in TTC when compared with MI.
评估应激性心肌病（TTC）患者的左心室（LV）扭转力学。
根据梅奥诊所标准，对17例连续的典型TTC患者[年龄78±8岁，女性占88%，平均左心室射血分数（LVEF）45±10%]在急性期（入院后24小时内）和恢复后（1个月后）进行二维应变和斑点追踪超声心动图测量左心室扭转。将17例年龄和性别匹配的对照（C）患者（平均LVEF 70±7%）以及17例在24小时前成功接受直接血管成形术治疗的急性前壁心肌梗死（MI）患者（LVEF、年龄和性别匹配）与TTC患者进行比较。使用胸骨旁基底和心尖短轴平面评估左心室扭转，定义为心尖（Ar）和基底旋转（Br）度数的净差值。从旋转和扭转曲线得出收缩期峰值、舒张早期、心尖（As和Ad）和基底（Bs和Bd）旋转速率，以及左心室扭转速率（TR）和解旋速率（UR）（单位为°/s）。将时间序列标准化为收缩期持续时间的百分比。在急性期，与对照组相比，TTC患者的Ar、As、Ad、Bs、左心室扭转（10±9°对23±6°）、左心室TR和左心室UR显著受损（均P<0.05）。MI患者表现出中间值（与TTC相比P=无显著性差异，与C组相比P<0.05）。然而，在就诊时心电图ST段抬高的患者亚组中（12例TTC和17例MI），与MI患者相比，TTC患者的几个左心室扭转力学参数显著降低，左心室扭转和左心室TR是最显著的因素（均P≤0.01）。3例（18%）TTC患者出现异常的反向Ar（从心尖看为顺时针方向），其他组未出现。在TTC组中观察到左心室扭转与LVEF、左心室容积、壁运动评分指数和血浆NT-pro BNP之间存在显著相关性（均P<0.05）。随访时，TTC患者的左心室扭转力学显著改善（与急性期相比均P<0.05），最终值与C组相似（均P=无显著性差异），而MI患者的改善幅度较小（与TTC相比P≤于0.05）。
TTC患者的左心室扭转力学显著受损，主要是由于心尖功能严重降低，且完全可逆。此外，在ST段抬高的患者亚组中，入院后早期评估时，与MI相比，TTC患者的左心室扭转力学受损更严重。
