心尖球形综合征：微血管功能障碍的又一血管造影证据。
Takotsubo Cardiomyopathy: One More Angiographic Evidence of Microvascular Dysfunction.
机构信息
Cardiology Clinic, UO Malattie Cardiovascolari, Fondazione IRCCS, Ospedale Maggiore Policlinico, Dipartimento di Scienze mediche e di Comunità, University of Milan, 20122 Milan, Italy.
Department of Cardiology, University of Palermo, 90127 Palermo, Italy.
出版信息
Biomed Res Int. 2018 Mar 14;2018:5281485. doi: 10.1155/2018/5281485. eCollection 2018.
BACKGROUND
Takotsubo cardiomyopathy (TC) aetiology has not been completely understood yet. One proposed pathogenic mechanism was coronary microvascular dysfunction (MVD). This study compared coronary flow and myocardial perfusion in patients with TC, microvascular angina (MVA), and a control group (CG).
METHODS
Out of 42 consecutive patients presented to our centre with TC from 2013 to 2017; we retrospectively selected 27 patients. We compared them with a sex- and age-matched group of 27 MVA cases and 27 patients with normal coronary arteries (CG). The flow was evaluated in the three coronary arteries as TIMI flow and TIMI frame count (TFC). Myocardial perfusion was studied with Blush-Score and Quantitative Blush Evaluator (QuBE).
RESULTS
TFC, in TC, revealed flow impairment in the three arteries compared to the CG (left anterior descending artery (LAD): 22 ± 8, 15 ± 4; = 0.001) (right coronary artery: 12 ± 4, 10 ± 3; = 0,025) (left circumflex: 14 ± 4, CG 11 ± 3; = 0,006). QuBE showed myocardial perfusion impairment in the LAD territory in TC comparing with both the CG (8,9 (7,2-11,5) versus 11,4 (10-15,7); = 0,008) and the MVA group (8,9 (7,2-11,5) versus 13,5 (10-16); = 0,006).
CONCLUSIONS
Our study confirmed that coronary flow is impaired in TC, reflecting a MVD. Myocardial perfusion defect was detected only in the LAD area.
背景
Takotsubo 心肌病（TC）的病因尚未完全阐明。一种提出的发病机制是冠状动脉微血管功能障碍（MVD）。本研究比较了 TC、微血管性心绞痛（MVA）和对照组（CG）患者的冠状动脉血流和心肌灌注。
方法
从 2013 年至 2017 年，我们中心连续收治了 42 例 TC 患者，回顾性选择了 27 例患者。我们将他们与 27 例性别和年龄匹配的 MVA 患者和 27 例正常冠状动脉患者（CG）进行比较。通过 TIMI 血流和 TIMI 帧数（TFC）评估三支冠状动脉的血流。用 Blush-Score 和定量 Blush 评估器（QuBE）研究心肌灌注。
结果
TC 组的 TFC 显示三支冠状动脉的血流与 CG 相比均受损（左前降支（LAD）：22 ± 8，15 ± 4； = 0.001）（右冠状动脉：12 ± 4，10 ± 3； = 0.025）（左旋支：14 ± 4，CG 11 ± 3； = 0.006）。QuBE 显示 TC 组的 LAD 区域心肌灌注受损，与 CG 组（8.9（7.2-11.5）与 11.4（10-15.7）； = 0.008）和 MVA 组（8.9（7.2-11.5）与 13.5（10-16）； = 0.006）相比。
结论
本研究证实，TC 患者的冠状动脉血流受损，反映了 MVD。仅在 LAD 区域检测到心肌灌注缺陷。
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