Chaumont Martin, Blaimont Marc, Briki Rachid, Unger Philippe, Debbas Nadia
Cardiology Department, CHU Saint-Pierre, 322 rue Haute, B-1000 Brussels, Belgium.
Cardiology Department, Hôpital de Jolimont, 7100 La Louvière, Belgium.
Case Rep Cardiol. 2020 Feb 21;2020:6562316. doi: 10.1155/2020/6562316. eCollection 2020.
A healthy 66-year-old female presented to the emergency department with acute chest pain, T-wave inversion in the anterior leads, and elevated troponin-I. Coronary angiography showed a stenosis in the midportion of the left anterior descending coronary artery (LAD), which did not wrap the left ventricle (LV) apex. LV angiography demonstrated a large LV apical akinetic systolic ballooning with a 45% ejection fraction. Fractional flow reserve (FFR) of LAD lesion was 0.71. Percutaneous intervention was performed. At six months, transthoracic echocardiography was normal. Fifteen months later, the patient presented with chest pain and a small rise in troponin-I. Coronary angiogram was unchanged. Repeat FFR in distal LAD was 0.86 and left ventriculography was normal. Diagnostic criteria for Takotsubo cardiomyopathy (TTC) require the absence of obstructive coronary artery disease. In the present case, TTC was highly suspected on the basis of typical LV apex ballooning. However, significant ischemia in the same territory was demonstrated by positive FFR, which could not be falsely positive in this context. Current TTC diagnostic criteria increase specificity for diagnosing TTC. This case reminds us that it is at the price of reduced sensitivity, since there is no reason to believe that coronary lesions may protect from TTC.
一名66岁健康女性因急性胸痛、前壁导联T波倒置和肌钙蛋白I升高就诊于急诊科。冠状动脉造影显示左前降支冠状动脉（LAD）中段狭窄，未包绕左心室（LV）心尖。左心室造影显示左心室心尖部大面积运动减弱的收缩期膨出，射血分数为45%。LAD病变的血流储备分数（FFR）为0.71。进行了经皮介入治疗。6个月时，经胸超声心动图正常。15个月后，患者出现胸痛，肌钙蛋白I略有升高。冠状动脉造影无变化。LAD远端重复FFR为0.86，左心室造影正常。应激性心肌病（TTC）的诊断标准要求无阻塞性冠状动脉疾病。在本病例中，基于典型的左心室心尖部膨出，高度怀疑为TTC。然而，FFR阳性表明同一区域存在明显缺血，在这种情况下不可能为假阳性。目前的TTC诊断标准提高了诊断TTC的特异性。本病例提醒我们，这是以降低敏感性为代价的，因为没有理由认为冠状动脉病变可以预防TTC。
