Agarwal Shvetank, Bean Matthew G, Hata J Steven, Castresana Manuel R
1 Augusta University, Augusta, GA, USA.
2 Cleveland Clinic, Cleveland, OH, USA.
Semin Cardiothorac Vasc Anesth. 2017 Dec;21(4):277-290. doi: 10.1177/1089253217700511. Epub 2017 Mar 23.
Takotsubo cardiomyopathy (TCM) is a condition that is characterized as a transient ventricular dysfunction in the absence of obstructive coronary artery disease (CAD) and is usually triggered by an acute medical illness or intense physical or emotional stress. Multiple cases of perioperative TCM (pTCM) have been reported from around the world, but a qualitative analysis of these cases has not yet been done. For this systematic review, we searched PubMed for case reports and case series of pTCM published from 1966 to April 2015 with the objective being to evaluate whether differences in demographics, clinical features and outcomes exist between pTCM and nonperioperative (npTCM), as well as to attempt to identify any predictors of the severe form of pTCM, which requires mechanical circulatory support (MCS) devices or leads to death. A total of 93 articles describing 102 cases were retrieved and reviewed. The findings were compared with the analysis of the International Takotsubo Registry by Templin et al and a systematic review of mainly non-perioperative TCM (npTCM) by Gianni et al. Although we were unable to identify definitive risk factors for pTCM, our review suggests that pTCM appears to occur in younger patients and with a lower likelihood of ST segment elevations and T-wave abnormalities than in npTCM. No demographic or clinical factors were identified that were predictive of more severe outcomes. As TCM in general can be a life-threatening event, it would therefore be prudent to consider pTCM within a differential diagnosis in any patient who decompensates in the perioperative period.
应激性心肌病（TCM）是一种在无阻塞性冠状动脉疾病（CAD）情况下表现为短暂性心室功能障碍的病症，通常由急性内科疾病或强烈的身体或情绪应激引发。世界各地均有围手术期应激性心肌病（pTCM）的多例报道，但尚未对这些病例进行定性分析。对于本系统评价，我们在PubMed中检索了1966年至2015年4月发表的pTCM病例报告和病例系列，目的是评估pTCM与非围手术期应激性心肌病（npTCM）在人口统计学、临床特征和结局方面是否存在差异，并试图确定pTCM严重形式的任何预测因素，pTCM的严重形式需要机械循环支持（MCS）设备或导致死亡。共检索并复习了描述102例病例的93篇文章。将研究结果与Templin等人对国际应激性心肌病注册研究的分析以及Gianni等人对主要是非围手术期应激性心肌病（npTCM）的系统评价进行了比较。尽管我们未能确定pTCM的确切危险因素，但我们的评价表明，与npTCM相比，pTCM似乎发生在较年轻的患者中，ST段抬高和T波异常的可能性较低。未发现可预测更严重结局的人口统计学或临床因素。由于一般来说应激性心肌病可能是危及生命的事件，因此对于围手术期失代偿的任何患者，在鉴别诊断时考虑pTCM是谨慎的做法。
