From the First Department of Medicine, Faculty of Medicine, University Medical Centre Mannheim (UMM), University of Heidelberg, Mannheim, Germany
DZHK (German Center for Cardiovascular Research), Partner Site, Heidelberg-Mannheim, Mannheim, Germany.
QJM. 2016 Dec;109(12):797-802. doi: 10.1093/qjmed/hcw092. Epub 2016 Jun 24.
Takotsubo cardiomyopathy (TTC) is a relevant differential diagnosis in patients presenting with signs of an acute coronary syndrome. Although recent literature has highlighted some salient features of this disorder, there has been little information elucidating the differences in clinical features, electrocardiographic findings, echocardiographic data and TTC-related complications associated with the different variants of TTC.
Our institutional database constituted a collective of 114 patients diagnosed with TTC between 2003 and 2015 and these patients were subsequently divided into two groups based on the presence (n = 82, 72%) or absence (n = 32, 28%) of the apical form of TTC. The protocol for our proposed study was approved by the Ethics Committee of the University Medical Centre in Mannheim. It was noticed that the patients presenting with the apical form of TTC belonged to an older age group as compared to those presenting with the non-apical form (61.1 ± 8.9 years vs. 69.5 ± 11.2; P < 0.01). The QTc interval prolongation at index-event was observed to be quantifiably greater in the 'apical variant' patients group (484.8 ± 57 ms vs. 464 ± 34.1 ms; P = 0.06). With respect to cardiovascular risk factors, patients with arterial hypertension did have a higher predilection to present with the apical form (63.4% vs. 43.7%; P = 0.06), however, the impact of smoking was less pronounced in this patient group (24.4% vs. 50%, P = 0.01). Furthermore, our study highlighted a significant impact on ejection fraction (EF), with a compromised left ventricular function (36 ± 9% vs. 42.4 ± 9.7%, P < 0.01) and greater involvement of the right ventricle in the apical variant patients group (23% vs. 3%, P = 0.04). Patients with the apical form also showed a greater tendency to develop TTC-related complications such as cardiogenic shock and required longer monitoring and care in comparison.
The apical and non-apical variants of TTC are manifestations of the same syndrome. They differ significantly, however, in their clinical presentation, related complications and prognosis.
应激性心肌病（Takotsubo 心肌病，TTC）是表现为急性冠状动脉综合征（acute coronary syndrome）的患者的一个重要鉴别诊断。尽管最近的文献强调了这种疾病的一些显著特征，但对于 TTC 不同变体的临床特征、心电图发现、超声心动图数据和 TTC 相关并发症之间的差异，信息仍然很少。
我们的机构数据库收集了 2003 年至 2015 年间诊断为 TTC 的 114 名患者，随后根据是否存在（n=82，72%）或不存在（n=32，28%）TTC 的心尖形式将这些患者分为两组。我们提出的研究方案得到了曼海姆大学医学中心伦理委员会的批准。与非心尖形式组相比，存在心尖形式 TTC 的患者年龄更大（61.1±8.9 岁 vs. 69.5±11.2 岁；P<0.01）。在指数事件时，心尖变异组的 QTc 间期延长可定量检测到更大（484.8±57ms vs. 464±34.1ms；P=0.06）。在心血管危险因素方面，高血压患者更倾向于心尖形式（63.4% vs. 43.7%；P=0.06），而吸烟对该患者组的影响较小（24.4% vs. 50%，P=0.01）。此外，我们的研究强调了射血分数（EF）的显著影响，心尖变异组的左心室功能受损（36±9% vs. 42.4±9.7%，P<0.01），右心室受累更多（23% vs. 3%，P=0.04）。心尖形式的患者也表现出更大的发生 TTC 相关并发症（如心源性休克）的倾向，并且需要更长时间的监测和护理。
TTC 的心尖和非心尖变体是同一综合征的表现。然而，它们在临床表现、相关并发症和预后方面存在显著差异。
