Casavecchia Grazia, Zicchino Stefano, Gravina Matteo, Maulucci Guglielmo, Manuppelli Vincenzo, Tarantino Nicola, Ruggiero Antonio, Russo Dolores, Santoro Francesco, Macarini Luca, Biase Matteo Di, Brunetti Natale Daniele
Cardiology Department, University of Foggia, Foggia, Italy.
Future Cardiol. 2017 Nov;13(6):529-532. doi: 10.2217/fca-2017-0018. Epub 2017 Oct 12.
We report the case of a 53-year-old woman admitted for typical chest pain and a diagnosis of Takotsubo syndrome (TTS). Initial echocardiographic presentation was characterized by apical and mid-ventricular akinesis and basal hyper-kinesis. Unexpectedly, later after admission, echocardiography showed recovered apical akinesis with an apparent 'migration' of systolic dysfunction to mid-ventricular segment and hyper-kinesis of apical and basal segments. One week after admission, left ventricular contractility completely recovered and cardiac magnetic resonance imaging did not show signs of subendocardial late-enhancement and myocardial edema. Cases of TTS may therefore occasionally rapidly 'wander' within left ventricular segments, raising doubts over the so far used classification of left ventricular patterns of ballooning in subjects with TTS (typical/atypical). Apparently, different patterns can rapidly evolve into each other. The absence of late-enhancement at cardiac magnetic resonance imaging could hypothetically identify rapidly 'wandering' cases.
我们报告了一例53岁女性因典型胸痛入院，诊断为Takotsubo综合征（TTS）。最初的超声心动图表现为心尖和心室中部运动减弱，基底段运动增强。出乎意料的是，入院后不久，超声心动图显示心尖运动减弱恢复，收缩功能障碍明显“迁移”至心室中部节段，心尖和基底段运动增强。入院一周后，左心室收缩力完全恢复，心脏磁共振成像未显示心内膜下延迟强化和心肌水肿迹象。因此，TTS病例可能偶尔会在左心室节段内迅速“游走”，这对目前TTS患者左心室球囊样扩张模式（典型/非典型）的分类提出了质疑。显然，不同模式可迅速相互演变。心脏磁共振成像未出现延迟强化可能理论上可识别迅速“游走”的病例。
