Yakupoglu H Yakup, Saeed Sahrai, Senior Roxy, Baksi A John, Lyon Alexander R, Khattar Rajdeep S
Department of Cardiology, Royal Brompton and Harefield NHS Trust, Sydney Street, London SW3 6NP, UK.
Cardiovascular Division, National Heart and Lung Institute, Imperial College, London, UK.
Eur Heart J Cardiovasc Imaging. 2020 Sep 18. doi: 10.1093/ehjci/jeaa237.
Takotsubo syndrome (TTS) is usually associated with rapid and spontaneous recovery of left ventricular (LV) function. However, a proportion of patients may have persistent symptoms. This study aimed to determine the haemodynamic and LV contractile responses to exercise in these patients.
Thirty symptomatic TTS patients referred for exercise echocardiography, a median of 15 months following the index TTS episode, were matched with 30 controls with normal exercise echocardiography. Beta-blockers were withheld prior to the test. LV volumes, ejection fraction (EF) and wall motion score index (WMSI), were measured at rest and stress. The TTS cohort were Caucasian women with mean age of 64.6 ± 7.4 years and similar coronary risk factor profile and EF to controls. Resting systolic blood pressure (SBP), LV end-diastolic volume, wall stress, and right ventricular fractional area change were higher in TTS patients compared with controls. Stress echo data showed similar exercise time, peak heart rate, and peak SBP in TTS patients vs. controls, but TTS patients had higher LV volumes, lower exercise LVEF (70 ± 10% vs. 78 ± 7%; P = 0.001), ΔLVEF (4 ± 8% vs. 12 ± 5%; P < 0.001), and WMSI (1.4 ± 0.4 vs. 1 ± 0; P < 0.001) compared with controls. Twenty TTS patients had clear exercise-induced wall motion abnormalities, mainly involving the apex or more globally, with a mean ΔLVEF of 1% compared with 12% in controls. Among the other 10 TTS patients, the ΔLVEF was 10%.
Symptomatic patients with previous TTS have a blunted contractile response to exercise. The therapeutic and prognostic implications of these findings need further investigation.
应激性心肌病（TTS）通常与左心室（LV）功能快速且自发恢复相关。然而，一部分患者可能会有持续症状。本研究旨在确定这些患者运动时的血流动力学和左心室收缩反应。
30例有症状的TTS患者在首次发生TTS事件后中位时间15个月接受运动超声心动图检查，并与30例运动超声心动图正常的对照者匹配。测试前停用β受体阻滞剂。在静息和应激状态下测量左心室容积、射血分数（EF）和壁运动评分指数（WMSI）。TTS队列是白种女性，平均年龄64.6±7.4岁，冠状动脉危险因素谱和EF与对照组相似。与对照组相比，TTS患者静息收缩压（SBP）、左心室舒张末期容积、壁应力和右心室面积变化分数更高。应激超声数据显示，TTS患者与对照组的运动时间、峰值心率和峰值SBP相似，但TTS患者左心室容积更大，运动时左心室射血分数更低（70±10%对78±7%；P=0.001），左心室射血分数变化（ΔLVEF）更小（4±8%对12±5%；P<0.001），WMSI更高（1.4±0.4对1±0；P<0.001）。20例TTS患者有明确的运动诱发壁运动异常，主要累及心尖或更广泛区域，平均ΔLVEF为1%，而对照组为12%。在其他10例TTS患者中，ΔLVEF为10%。
既往有TTS的有症状患者运动时收缩反应减弱。这些发现的治疗和预后意义需要进一步研究。
