The Heart Institute, Kaplan Medical Center, Rehovot, Hebrew University and Hadassah Medical School, Jerusalem, Israel.
Clin Cardiol. 2021 Jun;44(6):797-804. doi: 10.1002/clc.23604. Epub 2021 May 6.
Takotsubo cardiomyopathy (TCM) is characterized by transient left ventricle dysfunction.
A residual cardiac and endothelial dysfunction is present in patients who recovered from TCM.
In this single-center prospective study, patients with prior TCM were included and followed for 6.4 ± 1.6 years. All underwent comprehensive cardiac function assessment, including tissue Doppler imaging (TDI) and 2-dimensional strain (2DS) echocardiography at their first visit. The number of circulating endothelial progenitor cells and levels of proangiogenic vascular endothelial growth factor (VEGF) and its receptor (VEGF-R) were measured. All measurements were compared with healthy controls.
Forty-two women (age 58. ±8.6 years, LVEF 58.1 ± 6.1%) comprised the TCM group. Patients post-TCM had significantly lower early velocities E' (6 (5.0-8.0) vs. 9 (7.0-11.0) cm/s, p = .001) by TDI and higher E/E' ratio (p = .002), lower LV global average longitudinal strain (LGS) (-18.9 ± 3.5% vs. -21.7 ± 2.3%, p = .002) and RV LGS (-20.1 ± 3.9% vs. -23.4 ± 2.8%, p = .003) were evident. There was a trend toward a higher VEGF-R (p = .09) along with decreased VEGF/VEGF-R ratio representing inadequate VEGF production. In-hospital mortality was not reported and only two non-cardiac deaths occurred at long-term follow-up.
Altered TDI and 2DS indices suggest residual biventricular myocardial injury in post-TCM patients with the apparent LV function recovery. Inappropriate production of VEGF and VEGF-R were observed, suggesting a possible underlying endothelial dysfunction in these patients.
Takotsubo 心肌病（TCM）的特征是左心室短暂性功能障碍。
从 TCM 中恢复的患者存在残余的心脏和内皮功能障碍。
在这项单中心前瞻性研究中，纳入了先前患有 TCM 的患者，并进行了 6.4±1.6 年的随访。所有患者在首次就诊时均接受了全面的心脏功能评估，包括组织多普勒成像（TDI）和二维应变（2DS）超声心动图。测量循环内皮祖细胞的数量以及促血管生成血管内皮生长因子（VEGF）及其受体（VEGF-R）的水平。将所有测量值与健康对照组进行比较。
42 名女性（年龄 58.±8.6 岁，LVEF 58.1±6.1%）组成了 TCM 组。TCM 后患者的 TDI 早期速度 E'明显降低（6（5.0-8.0）比 9（7.0-11.0）cm/s，p=0.001），E/E'比值更高（p=0.002），左心室整体纵向应变（LGS）较低（-18.9±3.5%比-21.7±2.3%，p=0.002），右心室 LGS 也较低（-20.1±3.9%比-23.4±2.8%，p=0.003）。VEGF-R 呈升高趋势（p=0.09），而 VEGF/VEGF-R 比值降低，表明 VEGF 生成不足。住院期间未报告死亡率，仅在长期随访中发生 2 例非心脏死亡。
TDI 和 2DS 指标的改变提示 TCM 后患者存在双侧心室心肌损伤，尽管左心室功能已明显恢复。观察到 VEGF 和 VEGF-R 的产生不当，表明这些患者可能存在潜在的内皮功能障碍。
