Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institute and Karolinska University Hospital, Stockholm, Sweden.
Department of Medicine Solna, Karolinska Institutet, and Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
Clin Cardiol. 2021 Nov;44(11):1567-1574. doi: 10.1002/clc.23723. Epub 2021 Sep 7.
It is well-accepted that takotsubo syndrome (TS) is characterized by a massive surge of plasma catecholamines despite lack of solid evidence. The objective of this study was to examine the hypothesis of a massive catecholamine elevation in TS by studying plasma-free catecholamine metabolites in patients participating in the Stockholm myocardial infarction (MI) with normal coronaries 2 (SMINC-2) study where TS constituted more than one third of the patients.
The patients included in the SMINC-2 study were classified, according to cardiac magnetic resonance (CMR) imaging findings (148 patients), which was performed at a median of 3 days after hospital admission. Plasma-free catecholamine metabolites; metanephrine, normetanephrine, and methoxy-tyramine were measured on day 2-4 after admission. Catecholamine metabolite levels were available in 125 patients. One hundred and ten (88%) of the 125 patients included in SMINC-2 study, and 38 (86.4%) of the 44 patients with TS had completely normal plasma metanephrine and normetanephrine levels. All patients had normal plasma methoxy-tyramine levels. Fourteen (11.2%) of the 125 patients included in SMINC-2 study, and 5 (11.6%) of the 43 patients with TS had mild elevations (approximately 1.2 times the upper normal limits) of either plasma metanephrine or normetanephrine. One patient with pheochromocytoma-triggered TS had marked elevation of plasma metanephrine and mild elevation of plasma normetanephrine. There were no significant differences between the number or degree of catecholamine metabolite elevations between the different groups of patients with CMR imaging diagnosis included in SMINC-2 study.
There was no evidence of massive catecholamine elevations in the acute and subacute stages of TS apart from one patient with pheochromocytoma-induced TS. Most of the TS patients had normal catecholamine metabolites indicating that blood-borne catecholamines do not play a direct role in the pathogenesis of TS.
尽管缺乏确凿证据，但公认的是，心尖球囊样综合征（TS）的特征是血浆儿茶酚胺大量激增。本研究旨在通过研究参与斯德哥尔摩心肌梗死（MI）且冠状动脉正常 2 （SMINC-2）研究的患者的血浆游离儿茶酚胺代谢物来检验 TS 中存在大量儿茶酚胺升高的假设，其中 TS 占患者的三分之一以上。
根据心脏磁共振（CMR）成像检查结果（148 例患者）对 SMINC-2 研究中的患者进行分类，CMR 成像检查是在入院后中位数 3 天进行的。在入院后第 2-4 天测量血浆游离儿茶酚胺代谢物；甲氧基肾上腺素、去甲肾上腺素和甲氧基酪氨酸。儿茶酚胺代谢物水平可用于 125 例患者。在 SMINC-2 研究中，125 例患者中的 110 例（88%）和 44 例 TS 患者中的 38 例（86.4%）完全有正常的血浆甲氧基肾上腺素和去甲肾上腺素水平。所有患者的血浆甲氧基酪氨酸水平均正常。在 SMINC-2 研究中，125 例患者中的 14 例（11.2%）和 43 例 TS 患者中的 5 例（11.6%）有轻度升高（约为正常上限的 1.2 倍）的血浆甲氧基肾上腺素或去甲肾上腺素。一例嗜铬细胞瘤触发的 TS 患者有明显的血浆甲氧基肾上腺素升高和轻度的血浆去甲肾上腺素升高。在 SMINC-2 研究中纳入的不同 CMR 成像诊断组的患者中，儿茶酚胺代谢物升高的数量或程度之间没有差异。
除一例嗜铬细胞瘤诱导的 TS 患者外，在 TS 的急性和亚急性期没有发现儿茶酚胺大量升高的证据。大多数 TS 患者有正常的儿茶酚胺代谢物，表明血液源性儿茶酚胺在 TS 的发病机制中没有直接作用。
