Department of Cardiology, Gifu University Graduate School of Medicine, 1-1 Yanagido, Gifu, 501-1194, Japan.
J Cardiol. 2021 Apr;77(4):361-369. doi: 10.1016/j.jjcc.2020.10.004. Epub 2020 Oct 14.
Takotsubo cardiomyopathy or takotsubo syndrome (TTS) has become a well-known disease not only in Japan but also in the rest of the world. Early reports suggested that TTS is a self-limiting disease with better prognosis than acute coronary syndrome. However, recent data showed that TTS is not a benign disease as compared with acute coronary syndrome. In addition to the apical ballooning, several other types of wall motion abnormalities have been classified as variants of TTS. In particular, right ventricular involvement, or biventricular TTS, is not uncommon and is associated with poor in-hospital as well as long-term outcomes. With respect to the pathophysiology, modulation (desensitization) of the beta-adrenergic receptor is suspected as a possible mechanism for transiently depressed myocardial contraction. Although specific treatments to improve prognosis of TTS are still uncertain, observational data suggest favorable impact of angiotensin-converting enzyme inhibitors or angiotensin receptor blockers. Finally, in the era of COVID-19, we should pay attention to a variety of cardiovascular conditions related to COVID-19. TTS is one of these conditions that can be triggered by both emotional and physical impact of the COVID-19 pandemic.
心尖球囊样综合征（TTS）又称 Takotsubo 心肌病，它不仅在日本广为人知，在世界其他地区也同样如此。早期报告表明，TTS 是一种自限性疾病，其预后优于急性冠状动脉综合征。然而，最近的数据显示，与急性冠状动脉综合征相比，TTS 并不是一种良性疾病。除了心尖球囊样改变外，还有几种其他类型的室壁运动异常被归类为 TTS 的变体。特别是右心室受累或双心室 TTS 并不少见，与住院期间和长期预后不良有关。就其病理生理学而言，β-肾上腺素能受体的调节（脱敏）被怀疑是心肌收缩短暂抑制的可能机制。尽管改善 TTS 预后的具体治疗方法仍不确定，但观察性数据表明血管紧张素转换酶抑制剂或血管紧张素受体阻滞剂可能具有有益影响。最后，在 COVID-19 时代，我们应该注意与 COVID-19 相关的各种心血管疾病。TTS 就是其中一种可能由 COVID-19 大流行的情绪和身体影响引发的疾病。
