Mid-German Heart Center, Department of Internal Medicine III, Division of Cardiology, Angiology and Intensive Medical Care, University Hospital Halle, Martin-Luther-University Halle-Wittenberg, Ernst-Grube-Strasse 40, 06120, Halle (Saale), Germany.
Department of Thoracic and Cardiovascular Surgery, Klinikum Braunschweig, Brunswick, Germany.
Heart Fail Rev. 2020 Sep;25(5):757-771. doi: 10.1007/s10741-019-09843-9.
Takotsubo syndrome (TTS) is an acute and mostly reversible cardiomyopathy that mimics an acute coronary syndrome with left ventricular (LV) systolic dysfunction without relevant obstructive coronary artery disease. Its prevalence is probably underestimated and reaches 1.2-2% in patients with acute coronary syndrome undergoing coronary catheterization. Although supraphysiological epinephrine levels have been associated with TTS, the detailed pathophysiology is incompletely understood. Chest pain is the most common clinical presentation; however, cardiac decompensation, cardiogenic shock, and sudden cardiac death due to ventricular fibrillation may also be the first clinical manifestations. Patients are mostly postmenopausal women, in whom the condition is commonly associated with emotional triggers; however, men have a higher prevalence of TTS being associated with physical triggers, which has a worse prognosis compared with TTS associated with emotional triggers. As a diagnosis of exclusion, TTS has no single definitive diagnostic test. According to the distribution of LV wall motion abnormalities, various morphological subtypes have been identified. The final diagnosis depends on cardiac imaging with left ventricular angiography during acute heart catheterization, as well as on echocardiography and cardiac magnetic resonance. Most patients recover completely, albeit several factors have been associated with worse prognosis. Management is based on observational data, while randomized multicenter studies are still lacking. This review provides a general overview of TTS and focuses on the hypothesized pathophysiology, and especially on current practices in diagnosis, prognosis, and treatment.
心尖球囊样综合征（TTS）是一种急性且多为可逆性的心肌病，表现为左心室（LV）收缩功能障碍，类似于急性冠状动脉综合征，但无相关的阻塞性冠状动脉疾病。其患病率可能被低估，在接受冠状动脉造影检查的急性冠状动脉综合征患者中达到 1.2-2%。虽然超生理水平的肾上腺素与 TTS 有关，但详细的病理生理学机制尚不完全清楚。胸痛是最常见的临床表现；然而，心脏失代偿、心源性休克和因心室颤动导致的心脏性猝死也可能是首发临床表现。患者多为绝经后妇女，且常与情绪诱因有关；然而，男性中 TTS 更常见于与体力活动相关的诱因，与情绪诱因相关的 TTS 相比，其预后更差。由于是排他性诊断，TTS 没有单一的明确诊断测试。根据 LV 壁运动异常的分布，已确定了各种形态学亚型。最终诊断取决于急性心导管检查期间左心室造影的心脏影像学检查，以及超声心动图和心脏磁共振成像。大多数患者可完全恢复，但有几个因素与预后不良有关。管理基于观察性数据，而缺乏随机多中心研究。本综述提供了 TTS 的概述，重点介绍了假设的病理生理学，特别是当前在诊断、预后和治疗方面的实践。
