Y-Hassan Shams
Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institutet and Karolinska University Hospital, Stockholm, Sweden.
Cardiovasc Revasc Med. 2018 Dec;19(8S):2-4. doi: 10.1016/j.carrev.2018.05.012. Epub 2018 May 16.
Post-ischemic myocardial stunning (PIMS) is defined as a prolonged and reversible left ventricular dysfunction induced by an acute coronary ischemic insult. Takotsubo syndrome (TS) is a recognized acute cardiac disease entity, characterized by a unique pattern of transient circumferential left ventricular wall motion abnormality (LVWMA). The LVWMA in TS has all the characteristic features of myocardial stunning. Herein, the case of a 76-year-old woman with severe three-vessel coronary artery disease presented with acute coronary syndrome inducing PIMS with features identical to mid-apical pattern of TS is reported. The stunned myocardium caused incessant (throughout systole and diastole) compression of a segment of left anterior descending artery (LAD) with myocardial bridging during the acute and sub-acute stages of the disease. The systo-diastolic compression of LAD was relieved after recovery of LVWMA 26 days later. This novel observation suggests that the myocardial stunning in TS is in a cramp state during the acute and sub-acute stages of the disease. The cramp state of myocardial stunning may also explain the microvascular dysfunction seen in some patients with TS.
缺血后心肌顿抑（PIMS）被定义为由急性冠状动脉缺血性损伤引起的持续性且可逆的左心室功能障碍。Takotsubo综合征（TS）是一种公认的急性心脏疾病实体，其特征是独特的短暂性左心室壁环形运动异常（LVWMA）模式。TS中的LVWMA具有心肌顿抑的所有特征。在此，报告了一例76岁患有严重三支冠状动脉疾病的女性，其表现为急性冠状动脉综合征诱发PIMS，具有与TS的心尖中部模式相同的特征。在疾病的急性和亚急性阶段，顿抑心肌导致左前降支动脉（LAD）的一段在整个收缩期和舒张期持续受压，伴有心肌桥。26天后LVWMA恢复后，LAD的收缩 - 舒张期受压得以缓解。这一新颖的观察结果表明，TS中的心肌顿抑在疾病的急性和亚急性阶段处于痉挛状态。心肌顿抑的痉挛状态也可能解释了一些TS患者中出现的微血管功能障碍。
