Singh K, Parsaik A, Singh B
Department of Medicine, Queen Elizabeth Hospital, 28 Woodville Road, 5011, Woodville South, SA, Australia,
Herz. 2014 Dec;39(8):963-7. doi: 10.1007/s00059-013-3896-x. Epub 2013 Jul 25.
Takotsubo cardiomyopathy (TTC) is a transient left ventricular (LV) dysfunction that predominantly affects older women and has three main variants: apical, mid-ventricular, and basal. The recurrence rate of TTC is roughly around 11 % at 4-year follow-up. The pathogenesis of TTC is not clear and various theories have been proposed without concrete evidence.
We present a case series of 3 patients with recurrent TTC involving a different region of the ventricle during recurrence. All the patients presented with acute coronary syndrome (ACS) during the initial and recurrent episode. At the initial presentation, all the patients underwent selective coronary angiography (CA), transthoracic echocardiography (TTE), and cardiac magnetic resonance imaging (CMR) evaluation. However, the recurrent episodes were diagnosed without the need of CA, except in 1 patient who presented with ST-segment elevation myocardial infarction.
Recurrence of TTC is common and can be diagnosed without CA in some cases. During recurrence, the regional involvement of the left ventricle can vary in the same person. Variable regional involvement in the same patient rules out some of the proposed theories on the pathogenesis such as: beta-receptor gradient, wrap-around left anterior descending, and coronary artery spasm.
应激性心肌病（TTC）是一种短暂性左心室（LV）功能障碍，主要影响老年女性，有三种主要类型：心尖型、心室中部型和基底型。在4年的随访中，TTC的复发率约为11%。TTC的发病机制尚不清楚，虽已提出各种理论，但均无确凿证据。
我们报告了一组3例复发性TTC患者的病例系列，复发时累及心室的不同区域。所有患者在初次发作和复发时均表现为急性冠状动脉综合征（ACS）。初次就诊时，所有患者均接受了选择性冠状动脉造影（CA）、经胸超声心动图（TTE）和心脏磁共振成像（CMR）评估。然而，除1例表现为ST段抬高型心肌梗死的患者外，复发时无需进行CA即可诊断。
TTC复发很常见，在某些情况下无需进行CA即可诊断。复发时，同一患者左心室的受累区域可能不同。同一患者的可变区域受累排除了一些关于发病机制的理论，如：β受体梯度、左旋支环绕、冠状动脉痉挛。
