Aberdeen Cardiovascular and Diabetes Research Centre, University of Aberdeen, United Kingdom (C.S., A.R., A.M., H.W., J.S., P.B., D.K.D.).
Department of Biomathematics and Statistics Scotland, Aberdeen, United Kingdom (G.H.).
Circulation. 2018 Mar 6;137(10):1039-1048. doi: 10.1161/CIRCULATIONAHA.117.031841. Epub 2017 Nov 11.
Takotsubo cardiomyopathy is an increasingly recognized acute heart failure syndrome precipitated by intense emotional stress. Although there is an apparent rapid and spontaneous recovery of left ventricular ejection fraction, the long-term clinical and functional consequences of takotsubo cardiomyopathy are ill-defined.
In an observational case-control study, we recruited 37 patients with prior (>12-month) takotsubo cardiomyopathy, and 37 age-, sex-, and comorbidity-matched control subjects. Patients completed the Minnesota Living with Heart Failure Questionnaire. All participants underwent detailed clinical phenotypic characterization, including serum biomarker analysis, cardiopulmonary exercise testing, echocardiography, and cardiac magnetic resonance including cardiac P-spectroscopy.
Participants were predominantly middle-age (64±11 years) women (97%). Although takotsubo cardiomyopathy occurred 20 (range 13-39) months before the study, the majority (88%) of patients had persisting symptoms compatible with heart failure (median of 13 [range 0-76] in the Minnesota Living with Heart Failure Questionnaire) and cardiac limitation on exercise testing (reduced peak oxygen consumption, 24±1.3 versus 31±1.3 mL/kg/min, <0.001; increased VE/Vco slope, 31±1 versus 26±1, =0.002). Despite normal left ventricular ejection fraction and serum biomarkers, patients with prior takotsubo cardiomyopathy had impaired cardiac deformation indices (reduced apical circumferential strain, -16±1.0 versus -23±1.5%, <0.001; global longitudinal strain, -17±1 versus -20±1%, =0.006), increased native T1 mapping values (1264±10 versus 1184±10 ms, <0.001), and impaired cardiac energetic status (phosphocreatine/γ-adenosine triphosphate ratio, 1.3±0.1 versus 1.9±0.1, <0.001).
In contrast to previous perceptions, takotsubo cardiomyopathy has long-lasting clinical consequences, including demonstrable symptomatic and functional impairment associated with persistent subclinical cardiac dysfunction. Taken together our findings demonstrate that after takotsubo cardiomyopathy, patients develop a persistent, long-term heart failure phenotype.
URL: https://clinicaltrials.gov. Unique identifier: NCT02989454.
应激诱发的心肌顿抑综合征（Takotsubo 心肌病）是一种日益被认识的急性心力衰竭综合征。尽管左心室射血分数明显迅速且自发性恢复，但 Takotsubo 心肌病的长期临床和功能后果尚不清楚。
在一项观察性病例对照研究中，我们招募了 37 例有既往（>12 个月）Takotsubo 心肌病的患者，并匹配了 37 例年龄、性别和合并症相匹配的对照组患者。患者完成了明尼苏达心力衰竭生活质量问卷。所有参与者接受了详细的临床表型特征评估，包括血清生物标志物分析、心肺运动试验、超声心动图以及包括心脏 P 谱分析的心脏磁共振。
参与者主要为中老年（64±11 岁）女性（97%）。尽管 Takotsubo 心肌病在研究前 20 个月（范围 13-39 个月）发生，但大多数（88%）患者仍有与心力衰竭一致的持续症状（明尼苏达心力衰竭生活质量问卷中中位数为 13[0-76]）和运动试验中心脏受限（峰值耗氧量降低，24±1.3 比 31±1.3 mL/kg/min，<0.001；VE/VCO 斜率增加，31±1 比 26±1，=0.002）。尽管左心室射血分数和血清生物标志物正常，但既往有 Takotsubo 心肌病的患者存在心脏变形指数受损（心尖周向应变减少，-16±1.0 比-23±1.5%，<0.001；整体纵向应变减少，-17±1 比-20±1%，=0.006），T1 自然映射值增加（1264±10 比 1184±10 ms，<0.001），以及心脏能量状态受损（磷酸肌酸/γ-三磷酸腺苷比值，1.3±0.1 比 1.9±0.1，<0.001）。
与先前的认识相反，Takotsubo 心肌病具有持久的临床后果，包括与持续性亚临床心功能障碍相关的明显有症状和功能障碍。综合我们的发现表明，在 Takotsubo 心肌病之后，患者会发展出一种持续的、长期的心力衰竭表型。
