Bhanushali Aditi, Kohli Muskan, Prakash Ananya, Sarvepalli Svaapnika Rao, Pandey Anchal, Odugbemi Olufemi, Reyaz Nafisa, Trambadia Bansi, Reddy Sadhu Aishwarya, Chauhan Shaylika, Desai Rupak
Department of Internal Medicine, Mayo Clinic, Rochester, MN 55902, United States.
Department of Population Health & Leadership, University of New Haven, West Haven, CT 06516, United States.
World J Cardiol. 2023 Aug 26;15(8):406-414. doi: 10.4330/wjc.v15.i8.406.
Spontaneous coronary artery dissection (SCAD) is underdiagnosed and requires comprehensive angiographic findings. Few SCAD occurrences have a comparable clinical appearance as takotsubo syndrome (TTS) or exist simultaneously, making it challenging for clinicians to treat and manage. Case reports lack consolidated data. We examined SCAD-TTS case reports.
To conduct a systematic review of available case reports on SCAD in order to investigate its potential association with TTS.
SCAD-associated TTS case reports were reviewed after thoroughly screening PubMed, EMBASE, Scopus, and Google Scholar databases till January 2023. Case reports described demographics, comorbidities, imaging, management, and results.
Twelve articles about 20 female patients were analyzed. 30% of patients ( = 6, > 60 years) were elderly (mean age 56.2 ± 9.07 years, range 36-70 years). Canada has 9 cases, United States 3, Australia 3, Sweden 2, Japan, Denmark, and France 1. Only 5 reports identified emotional stressors in these cases while 4 reports showed physical triggers for TTS. Nine had hypertension, 2 had hyperlipidemia, and 1 had prediabetes. 5 patients (25%) smoked. 10 (50%) troponin-positive myocardial infarction patients reported chest discomfort. 11 (55%) of 20 instances had TTS/SCAD. 12 (60%) of 20 patients exhibited ST elevation and 3 (15%) had T wave inversion on electrocardiogram. 19/20 patients had elevated troponin. 9 (45%) of 20 people had apical akinesis with TTS ballooning on cardiac imaging. All 20 exhibited echocardiographic wall motion abnormalities. 19 (95%) of 20 coronary angiography cases had SCAD. 10 of 19 SCAD patients had left anterior descending, 2 diagonal, and 2 left circumflex coronary artery involvement. 7 of 20 patients had left ventricular ejection fraction (LVEF) data. LVEF averaged 38.78 ± 7.35%. 5 (25%) of the 20 cases underwent dual antiplatelet therapy. Three (15%) of 20 cases experienced occasional ectopic ventricular complexes, Mobitz ll AV block, and paroxysmal atrial fibrillation. All 20 cases recovered and survived.
Given the clinical similarities and challenges in detecting TTS and SCAD, this subset needs more research to raise awareness and reduce morbidity.
自发性冠状动脉夹层（SCAD）诊断不足，需要全面的血管造影检查结果。很少有SCAD病例具有与应激性心肌病（TTS）相似的临床表现或同时存在，这给临床医生的治疗和管理带来了挑战。病例报告缺乏综合数据。我们对SCAD-TTS病例报告进行了研究。
对现有的SCAD病例报告进行系统综述，以调查其与TTS的潜在关联。
在对PubMed、EMBASE、Scopus和谷歌学术数据库进行全面筛选后，对截至2023年1月的SCAD相关TTS病例报告进行了综述。病例报告描述了人口统计学、合并症、影像学、治疗和结果。
分析了12篇关于20名女性患者的文章。30%的患者（n = 6，年龄>60岁）为老年人（平均年龄56.2±9.07岁，范围36 - 70岁）。加拿大有9例，美国3例，澳大利亚3例，瑞典2例，日本、丹麦和法国各1例。这些病例中只有5份报告确定了情绪应激源，而4份报告显示了TTS的身体触发因素。9例有高血压，2例有高脂血症，1例有糖尿病前期。5例患者（25%）吸烟。10例（50%）肌钙蛋白阳性的心肌梗死患者报告有胸部不适。20例中有11例（55%）患有TTS/SCAD。20例患者中有12例（
