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冠状动脉痉挛相关的应激性心肌病的二维心肌变形：一项连续超声心动图研究的病例报告

Two-dimensional myocardial deformation in coronary vasospasm-related Takotsubo cardiomyopathy: A case report of a serial echocardiographic study.

作者信息

Hung Ming-Jui, Ko Ta, Liang Chung-Yu, Kao Yu-Cheng

机构信息

Section of Cardiology, Department of Internal Medicine, Chang Gung Memorial Hospital, Keelung Chang Gung University College of Medicine, Taoyuan, Taiwan.

出版信息

Medicine (Baltimore). 2017 Oct;96(40):e8232. doi: 10.1097/MD.0000000000008232.

DOI:10.1097/MD.0000000000008232
PMID:28984779
原文链接:https://pmc.ncbi.nlm.nih.gov/articles/PMC5738015/
Abstract

RATIONALE

Although transient reduction in the left ventricular ejection fraction is characteristic of Takotsubo cardiomyopathy, little is known about the time-course changes of myocardial deformation in coronary vasospasm-related Takotsubo cardiomyopathy.

PATIENT CONCERNS

We retrospectively analyzed the time-course changes in left ventricle, right ventricle, and left atrium strain values in a patient with coronary vasospasm-related Takotsubo cardiomyopathy. We found that not only left ventricular strain but also left atrial strain was abnormal during acute Takotsubo cardiomyopathy due to coronary vasospasm. Right ventricular free wall strain was normal.

DIAGNOSES

Coronary vasospasm-related Takotsubo cardiomyopathy.

INTERVENTIONS

A serial echocardiographic study.

OUTCOMES

The left ventricular strain was still subnormal despite a normalized left ventricular ejection fraction 2 months later. The left atrial strain was normal when the left ventricular ejection fraction normalized.

LESSONS

From this limited experience, it is suggested that echocardiographic myocardial deformation analysis can provide more information than the standard ejection fraction in evaluating myocardial contractile function.

摘要

理论依据

虽然左心室射血分数短暂降低是应激性心肌病的特征，但对于冠状动脉痉挛相关的应激性心肌病中心肌变形的时间进程变化知之甚少。

患者情况

我们回顾性分析了一名冠状动脉痉挛相关应激性心肌病患者左心室、右心室和左心房应变值的时间进程变化。我们发现，在因冠状动脉痉挛导致的急性应激性心肌病期间，不仅左心室应变异常，左心房应变也异常。右心室游离壁应变正常。

诊断

冠状动脉痉挛相关应激性心肌病。

干预措施

系列超声心动图研究。

结果

尽管2个月后左心室射血分数恢复正常，但左心室应变仍低于正常水平。当左心室射血分数恢复正常时，左心房应变正常。

经验教训

从这一有限的经验来看，提示在评估心肌收缩功能时，超声心动图心肌变形分析比标准射血分数能提供更多信息。

https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e299/5738015/973e5d2f651c/medi-96-e8232-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e299/5738015/9e6480f89392/medi-96-e8232-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e299/5738015/973e5d2f651c/medi-96-e8232-g002.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e299/5738015/9e6480f89392/medi-96-e8232-g001.jpg
https://cdn.ncbi.nlm.nih.gov/pmc/blobs/e299/5738015/973e5d2f651c/medi-96-e8232-g002.jpg

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I-MIBG Scintigraphy in the Subacute State of Takotsubo Cardiomyopathy.
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Contemporary review on the pathogenesis of takotsubo syndrome: The heart shedding tears: Norepinephrine churn and foam at the cardiac sympathetic nerve terminals.当代关于应激性心肌病发病机制的综述：心脏在流泪：去甲肾上腺素在心脏交感神经末梢搅动并起泡沫。
Int J Cardiol. 2017 Feb 1;228:528-536. doi: 10.1016/j.ijcard.2016.11.086. Epub 2016 Nov 9.
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