Cardiology Department, ARC, Ospedale Civile.
Cardiology Clinic, Policlinico San Giorgio, Pordenone, Italy.
J Cardiovasc Med (Hagerstown). 2018 Dec;19(12):717-724. doi: 10.2459/JCM.0000000000000729.
The aim of this study is to report the heterogeneity of clinical presentation in Tako-Tsubo syndrome (TTS), including a significant prevalence of normal ECG and echocardiographic patterns in a series of consecutive patients from a single center.
From our database we selected a total of 168 cases of TTS. A total of 140 of these (Group A); 14 men (10%), mean age 60.3 years, range 39-87; 126 women (90%), mean age 66.1 years, range 43-93; matched the following reported criteria: typical stenocardic pain immediately following an emotional acute stress, or acute medical or surgical event within the preceding 12 h; acute rise and fall of troponin release; absence of significant coronary disease at coronary angiography. ECG findings at presentation ranged from T wave abnormalities (41 cases, 29.3%) to ST elevation (52 cases, 37.1%) and ST depression (11 cases, 7.9%), whereas in 36 cases (25.7%) the ECG was normal. Echocardiography at presentation showed akinesia of the total apical or medium-apical segments in 74 patients (53%), whereas it showed akinesia of left ventricular wall segments in other locations in 30 patients (21%) and even normal regional wall motion and thickening in 36 patients (26%). We described also a series of 13 female patients (mean age 70.2 years; age range 45-85 years) (Group B) who did not complain of chest pain at presentation, but showed a classical Tako-Tsubo evolution of wall motion abnormalities at echocardiography. Finally we selected 15 female patients (mean age 69.3 years; age range 49-89 years) (Group C) who formally did not report acute stress immediately preceding their presentation to the hospital for chest pain. They showed a classical Tako-Tsubo evolution of wall motion abnormalities at echocardiography and only one case of normal ECG pattern at presentation.
In this series of acute TTS, a wide variability of ECG and echocardiographic patterns are observed, ranging from ST elevation with coexisting segmental wall motion abnormalities of the typical TTS to a clinical presentation characterized by normal ECG and normal segmental wall motion pattern.
本研究旨在报告心尖球囊样综合征（Tako-Tsubo 综合征，TTS）临床表现的异质性，包括来自单一中心的一系列连续患者中存在显著比例的正常心电图和超声心动图表现。
我们从数据库中选择了总共 168 例 TTS 患者。其中 140 例（A 组）符合以下报告标准：典型心绞痛样疼痛，紧随情绪急性应激之后，或在 12 小时内发生急性医疗或外科事件；肌钙蛋白释放的急性升高和降低；冠状动脉造影无明显冠状动脉疾病。就诊时心电图发现从 T 波异常（41 例，29.3%）到 ST 段抬高（52 例，37.1%）和 ST 段压低（11 例，7.9%），而 36 例（25.7%）心电图正常。就诊时超声心动图显示全心尖段或中-心尖段运动障碍 74 例（53%），而其他部位左心室壁节段运动障碍 30 例（21%），甚至 36 例（26%）局部室壁运动和增厚正常。我们还描述了一组 13 例女性患者（平均年龄 70.2 岁；年龄范围 45-85 岁）（B 组），她们就诊时没有胸痛，但超声心动图显示经典的 Tako-Tsubo 室壁运动异常演变。最后，我们选择了 15 例女性患者（平均年龄 69.3 岁；年龄范围 49-89 岁）（C 组），她们就诊时明确没有报告急性应激。她们在超声心动图上表现出典型的 Tako-Tsubo 室壁运动异常演变，仅有 1 例就诊时心电图正常。
在本系列急性 TTS 中，观察到心电图和超声心动图表现的广泛变异性，范围从伴有典型 TTS 节段性壁运动异常的 ST 段抬高到以正常心电图和正常节段性壁运动模式为特征的临床表现。
