Department of Cardiology, Bridgeport Hospital, Bridgeport, Connecticut.
Clin Cardiol. 2013 Sep;36(9):531-4. doi: 10.1002/clc.22154. Epub 2013 Jun 24.
Stress cardiomyopathy manifests as reversible left ventricular apical ballooning in the absence of epicardial coronary obstruction. Transient microcirculatory dysfunction has been proposed as a potential putative mechanism. This study aimed to understand the natural history of this dysfunction using readily available noninvasive methods.
Stress cardiomyopathy presents with profound microvascular dysfunction that improves quickly over a period of 3 to 4 weeks.
Nine consecutive patients with Takotsubo cardiomyopathy were followed serially with myocardial perfusion echocardiograms at 24 hours, within 1 week, and 3 to 6 months after index admission.
The mean left ventricular ejection fraction (LVEF) steadily improved from 38% at baseline to 48% within 1 week to 67% by the end of 3 to 6 months follow-up. The number of wall segments with reduced or absent perfusion decreased from 4.1 at baseline to 2 at 1 week. By 3 to 6 months, perfusion had returned to normal in all but 1 segment in 1 patient. At 1 week, the relative improvement in mean LVEF was 26%, whereas perfusion had improved by nearly 50%, suggesting a fairly pronounced improvement in microcirculatory function prior to recovery of wall motion.
Patients with Takotsubo cardiomyopathy present with significant acute microcirculatory dysfunction that recovers quickly prior to the recovery of regional wall motion abnormalities.
应激性心肌病表现为左心室心尖部球囊样改变，而无心外膜冠状动脉阻塞。短暂性微血管功能障碍被认为是一种潜在的发病机制。本研究旨在通过易于获得的非侵入性方法来了解这种功能障碍的自然病程。
应激性心肌病表现为严重的微血管功能障碍，在 3 至 4 周内迅速改善。
连续 9 例 Takotsubo 心肌病患者在 24 小时、1 周内和指数入院后 3 至 6 个月进行心肌灌注超声心动图随访。
左心室射血分数（LVEF）从基线时的 38%逐渐改善，1 周内达到 48%，3 至 6 个月随访时达到 67%。壁段灌注减少或消失的数量从基线时的 4.1 个减少到 1 周时的 2 个。在 1 名患者中，除 1 个节段外，所有节段的灌注在 3 至 6 个月时均恢复正常。在 1 周时，平均 LVEF 的相对改善率为 26%，而灌注改善了近 50%，这表明在节段性壁运动恢复之前，微血管功能已经有了相当大的改善。
Takotsubo 心肌病患者存在明显的急性微血管功能障碍，在区域性壁运动异常恢复之前迅速恢复。
