Kumai Tadashi, Inamasu Joji, Watanabe Eiichi, Sugimoto Keiko, Hirose Yuichi
Department of Neurosurgery, Fujita Health University Hospital, Toyoake, Japan.
Department of Cardiology, Fujita Health University Hospital, Toyoake, Japan.
Int J Cardiol Heart Vasc. 2016 May 11;11:99-103. doi: 10.1016/j.ijcha.2016.05.010. eCollection 2016 Jun.
Both Takotsubo cardiomyopathy (TTC) and reverse TTC (r-TTC) are characterized by reversible regional wall motion abnormalities of the heart unrelated to coronary artery pathology. It remains unclear whether and/or how r-TTC differs from TTC. Subarachnoid hemorrhage (SAH) is occasionally causative of TTC/r-TTC, and this study was conducted to detect possible differences between TTC and r-TTC associated with SAH.
A single-center retrospective study was conducted on 328 consecutive SAH patients. They routinely underwent transthoracic echocardiography (TTE), ECG, and measurements of plasma catecholamines and other cardiac biomarkers within 24 h of admission. Demographic, echocardiographic, electrocardiographic and neurochemical profiles were compared between patients with TTC and r-TTC. The diagnosis of TTC/r-TTC was based on the revised Mayo Clinic Criteria.
Data of 21 SAH-induced TTC and 10 SAH-induced r-TTC patients admitted between January 2009 and December 2014 were analyzed. The patients with r-TTC were significantly younger than those with TTC (51.8 ± 10.9 vs. 63.5 ± 14.4 years, = 0.04). The former exhibited significantly higher plasma epinephrine levels than the latter (809 ± 710 vs. 380 ± 391 pg/mL, = 0.04). Plasma norepinephrine levels did not differ significantly (2421 ± 1374 vs. 1724 ± 1591 pg/mL, = 0.25). No significant differences were observed in other demographic/physiologic variables, echocardiographic parameters, frequency of ECG abnormalities, and 90-day mortality. Moreover, none of the patients who underwent a follow-up TTE exhibited morphologic change from one type to the other.
The pathomechanisms in TTC and r-TTC may not be identical: however, distinguishing the two conditions may not have great importance from the standpoint of clinical management and prognostication.
应激性心肌病（TTC）和反向应激性心肌病（r-TTC）均以与冠状动脉病变无关的心脏可逆性节段性室壁运动异常为特征。r-TTC与TTC是否存在差异以及如何存在差异仍不明确。蛛网膜下腔出血（SAH）偶尔可导致TTC/r-TTC，本研究旨在检测与SAH相关的TTC和r-TTC之间可能存在的差异。
对328例连续的SAH患者进行单中心回顾性研究。患者在入院后24小时内常规接受经胸超声心动图（TTE）、心电图检查，并测定血浆儿茶酚胺及其他心脏生物标志物。比较TTC和r-TTC患者的人口统计学、超声心动图、心电图及神经化学特征。TTC/r-TTC的诊断基于修订后的梅奥诊所标准。
分析了2009年1月至2014年12月期间收治的21例SAH诱发TTC患者和10例SAH诱发r-TTC患者的数据。r-TTC患者比TTC患者明显年轻（51.8±10.9岁对63.5±14.4岁；P = 0.04）。前者血浆肾上腺素水平显著高于后者（809±710对380±391 pg/mL；P = 0.04）。血浆去甲肾上腺素水平无显著差异（2421±1374对1724±1591 pg/mL；P = 0.25）。在其他人口统计学/生理学变量、超声心动图参数、心电图异常频率及90天死亡率方面未观察到显著差异。此外，接受随访TTE检查的患者均未出现从一种类型转变为另一种类型的形态学变化。
TTC和r-TTC的发病机制可能并不相同；然而，从临床管理和预后判断的角度来看，区分这两种情况可能并不十分重要。
