Department of Cardiology, National University Heart Centre.
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore.
Rheumatology (Oxford). 2021 Jan 5;60(1):11-22. doi: 10.1093/rheumatology/keaa504.
Since its description in 1990, Takotsubo syndrome (TTS), an acute cardiac condition triggered by physical or emotional stress, has been believed to be related to catecholamine surge from overwhelming sympathetic activity. While symptomatology, biochemical features, ECG and echocardiogram alterations are largely indistinguishable from acute coronary syndrome, the absence of culprit coronary lesions often necessitates further investigations, uncovering underlying inflammatory processes. Mechanistically, animal models of TTS reveal early neutrophil infiltration followed by staged ingression of two subtypes of macrophages (M1, M2) mediating initial acute inflammatory changes (M1), followed by switching to anti-inflammatory signals (M2) that enhance myocardial tissue recovery. Here, we begin with a description of two TTS patients with primary Sjögren's syndrome and Takayasu's arteritis, followed by a systematic literature review that summarizes the demographic and clinical features of TTS patients with rheumatological conditions. Potential impact of disease manifestations and treatment of rheumatological conditions on TTS are critically discussed.
自 1990 年描述以来，Takotsubo 综合征（TTS），一种由身体或情绪压力引发的急性心脏疾病，被认为与交感神经活动过度引起的儿茶酚胺激增有关。虽然症状、生化特征、心电图和超声心动图改变与急性冠状动脉综合征在很大程度上难以区分，但缺乏罪魁祸首的冠状动脉病变通常需要进一步调查，揭示潜在的炎症过程。从机制上讲，TTS 的动物模型显示早期中性粒细胞浸润，随后两种类型的巨噬细胞（M1、M2）分阶段侵入，介导初始急性炎症变化（M1），然后切换到抗炎信号（M2），增强心肌组织恢复。在这里，我们首先描述了两名患有原发性干燥综合征和 Takayasu 动脉炎的 TTS 患者，然后进行了系统的文献复习，总结了患有风湿性疾病的 TTS 患者的人口统计学和临床特征。还批判性地讨论了风湿性疾病的临床表现和治疗对 TTS 的潜在影响。
