Y-Hassan Shams
Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institutet and Karolinska University Hospital Stockholm, Sweden.
Am J Cardiovasc Dis. 2021 Apr 15;11(2):184-193. eCollection 2021.
Takotsubo syndrome (TS) is an acute cardiac disease entity, characterized by a transient myocardial stunning in a distinctive predominantly regional circumferential pattern. One of the discussed pathological mechanisms of TS is coronary ischemia including coronary microvascular dysfunction (CMVD). Many studies have revealed invasive or non-invasive signs of CMVD in patients with TS, and therefore some investigators believe that CMVD is the primary cause of TS. Nevertheless, other studies have not shown any sign of CMVD. In addition, those studies, which have shown signs of CMVD, do not reveal such signs in all the three coronary vessel distribution; some of the patients show signs of CMVD in two or only one coronary artery territory. Moreover, signs of CMVD in TS are more prevalent and more pronounced in the left anterior descending artery (LAD) distribution. The CMVD in TS is reversible in a pattern parallel to the improvement of myocardial wall motion abnormality. In this review, substantial evidences challenging CMVD as the primary cause of TS and supporting the concept that CMVD is a secondary or epiphenomenon in TS are provided. Furthermore, convincing explanation is given for the causes of the more prevalent and the more pronounced signs of CMVD observed in the LAD distribution.
应激性心肌病（TS）是一种急性心脏疾病实体，其特征是在一种独特的、主要为区域性的圆周模式下出现短暂性心肌顿抑。TS所讨论的病理机制之一是冠状动脉缺血，包括冠状动脉微血管功能障碍（CMVD）。许多研究已经揭示了TS患者中CMVD的有创或无创迹象，因此一些研究者认为CMVD是TS的主要原因。然而，其他研究并未显示出CMVD的任何迹象。此外，那些显示出CMVD迹象的研究并未在所有三支冠状动脉分布中均揭示出此类迹象；一些患者仅在两支冠状动脉区域或仅在一支冠状动脉区域显示出CMVD迹象。而且，TS中CMVD的迹象在左前降支（LAD）分布中更为普遍且更为明显。TS中的CMVD会随着心肌壁运动异常的改善而以一种平行的模式逆转。在本综述中，提供了大量证据对CMVD作为TS主要原因提出质疑，并支持CMVD是TS中的一种继发性或附带现象这一概念。此外，还对在LAD分布中观察到的CMVD迹象更为普遍且更为明显的原因给出了令人信服的解释。
