Desai Aarti, Ruiz Jose, Shapiro Anna, Klingbeil Rebecca, Martin Archer, Goswami Rohan
Division of Heart Failure and Transplantation, Mayo Clinic, Jacksonville, FL 32224, USA.
Department of Anesthesia and Perioperative Medicine, Mayo Clinic, Jacksonville, FL 32224, USA.
J Clin Med. 2025 Sep 5;14(17):6278. doi: 10.3390/jcm14176278.
: Takotsubo cardiomyopathy (TCM), also known as stress cardiomyopathy or Broken Heart Syndrome, is a reversible, transient state of myocardial dyskinesis and apical ballooning. Infrequently, TCM may progress to severe life-threatening complications such as cardiogenic shock. Early mechanical circulatory support (MCS) is crucial to myocardial recovery in these cases. We present one of the first cases of TCM successfully treated with the advanced micro-axial minimally invasive Impella 5.5 with SmartAssist MCS device. : A female in her late 70s with a history of hypothyroidism, atrial fibrillation post-ablation, and cholelithiasis was referred to our facility for an elective cholecystectomy. Post-anesthesia induction with propofol 2.1 mg/kg (140 mg bolus), she became bradycardic and hypotensive, eventually leading to asystole, requiring CPR and termination of the procedure. Echocardiography revealed a left ventricular ejection fraction (LVEF) of 24% with mid-ventricular akinesis and apical ballooning with mild mitral regurgitation, suggesting the diagnosis of TCM. Cardiac catheterization showed RA 20 and mean PA 42 mmHg. Lactate was 18.7 mmol/L and LDH 1776 U/L, suggesting progressive shock. Continuous epinephrine 0.1 mcg/kg/min and norepinephrine 0.06 mcg/kg/min were titrated for BP 97/58, and she was initially supported with the Impella CP device. Despite aggressive efforts, rising LDH levels and increased vasopressor needs indicated inadequate organ perfusion, requiring an upgrade to Impella 5.5. Impella 5.5 support for 11 days led to impressive myocardial recovery, leading to reductions, and eventual discontinuation, of inotropes and vasopressors. Post-Impella 5.5 explantation, her LVEF was 59-65% and she was discharged with Mobile Cardiac Outpatient Telemetry (MCOT) monitoring for her arrhythmias and reinitiation of guideline-directed medical therapies (GDMTs) for her comorbidities. Her 2-month follow-up shows sustained LVEF greater than 45% with functional improvements. : Early escalation within 24 h of Impella CP to Impella 5.5 provided stabilization of cardiometabolic shock, preventing end-organ damage, allowing recovery of native heart function while maintaining ambulatory status, and allowing for optimizing medical therapy. It presents a safe, minimally invasive, and cost-effective intervention in TCM cases refractory to GDMT or when additional time is needed for decision-making in cases presenting with CS.
应激性心肌病（TCM），也被称为应激性心肌病或心碎综合征，是一种可逆的、短暂的心肌运动障碍和心尖部气球样变状态。TCM很少会进展为严重的危及生命的并发症，如心源性休克。在这些情况下，早期机械循环支持（MCS）对心肌恢复至关重要。我们介绍了首例成功使用先进的微轴微创Impella 5.5及SmartAssist MCS设备治疗的TCM病例。
一名70多岁的女性，有甲状腺功能减退、房颤消融术后和胆结石病史，因择期胆囊切除术转诊至我院。在使用2.1mg/kg丙泊酚（140mg推注）进行麻醉诱导后，她出现心动过缓和低血压，最终导致心脏停搏，需要进行心肺复苏并终止手术。超声心动图显示左心室射血分数（LVEF）为24%，心室中部运动减弱，心尖部气球样变伴轻度二尖瓣反流，提示TCM诊断。心导管检查显示右心房压20mmHg，平均肺动脉压42mmHg。乳酸水平为18.7mmol/L，乳酸脱氢酶（LDH）为1776U/L，提示休克进展。持续给予肾上腺素0.1mcg/kg/min和去甲肾上腺素0.06mcg/kg/min以维持血压97/58mmHg，她最初使用Impella CP设备进行支持。尽管积极治疗，但LDH水平不断升高和血管升压药需求增加表明器官灌注不足，需要升级为Impella 5.5。使用Impella 5.5支持11天导致心肌显著恢复，从而减少并最终停用了强心药和血管升压药。在移除Impella 5.5后，她的LVEF为59%-65%，出院时接受移动心脏门诊遥测（MCOT）监测心律失常，并重新开始针对其合并症的指南指导药物治疗（GDMT）。她的2个月随访显示LVEF持续大于45%，功能有所改善。
在Impella CP使用24小时内尽早升级为Impella 5.5可稳定心代谢性休克，防止终末器官损伤，使心脏自身功能恢复，同时维持活动状态，并优化药物治疗。它为对GDMT难治的TCM病例或在出现心源性休克（CS）时需要额外时间进行决策的病例提供了一种安全、微创且经济有效的干预措施。
