BACKGROUND Takotsubo cardiomyopathy is an increasingly recognized acute heart failure syndrome precipitated by intense emotional stress. Although there is an apparent rapid and spontaneous recovery of left ventricular ejection fraction, the long-term clinical and functional consequences of takotsubo cardiomyopathy are ill-defined. METHODS In an observational case-control study, we recruited 37 patients with prior (>12-month) takotsubo cardiomyopathy, and 37 age-, sex-, and comorbidity-matched control subjects. Patients completed the Minnesota Living with Heart Failure Questionnaire. All participants underwent detailed clinical phenotypic characterization, including serum biomarker analysis, cardiopulmonary exercise testing, echocardiography, and cardiac magnetic resonance including cardiac 31P-spectroscopy. RESULTS Participants were predominantly middle-age (64±11 years) women (97%). Although takotsubo cardiomyopathy occurred 20 (range 13-39) months before the study, the majority (88%) of patients had persisting symptoms compatible with heart failure (median of 13 [range 0-76] in the Minnesota Living with Heart Failure Questionnaire) and cardiac limitation on exercise testing (reduced peak oxygen consumption, 24±1.3 versus 31±1.3 mL/kg/min, P<0.001; increased VE/Vco2 slope, 31±1 versus 26±1, P=0.002). Despite normal left ventricular ejection fraction and serum biomarkers, patients with prior takotsubo cardiomyopathy had impaired cardiac deformation indices (reduced apical circumferential strain, -16±1.0 versus -23±1.5%, P<0.001; global longitudinal strain, -17±1 versus -20±1%, P=0.006), increased native T1 mapping values (1264±10 versus 1184±10 ms, P<0.001), and impaired cardiac energetic status (phosphocreatine/γ-adenosine triphosphate ratio, 1.3±0.1 versus 1.9±0.1, P<0.001). CONCLUSIONS In contrast to previous perceptions, takotsubo cardiomyopathy has long-lasting clinical consequences, including demonstrable symptomatic and functional impairment associated with persistent subclinical cardiac dysfunction. Taken together our findings demonstrate that after takotsubo cardiomyopathy, patients develop a persistent, long-term heart failure phenotype. CLINICAL TRIAL REGISTRATION URL: https://clinicaltrials.gov. Unique identifier: NCT02989454.

中文翻译：

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应激诱导的（Takotsubo）心肌病后持续的长期结构，功能和代谢变化。

背景技术Takotsubo心肌病是一种日益受到认可的急性心力衰竭综合症，其由强烈的情绪压力引起。尽管左心室射血分数明显快速且自发恢复，但takotsubo心肌病的长期临床和功能后果尚不明确。方法在一项观察性病例对照研究中，我们招募了37例既往（> 12个月）takotsubo心肌病的患者，以及37例年龄，性别和合并症相匹配的对照对象。患者完成了《明尼苏达州心衰患者生活状况调查表》。所有参与者均进行了详细的临床表型表征，包括血清生物标志物分析，心肺运动测试，超声心动图和包括心脏31P光谱在内的心脏磁共振。结果参与者主要是中年（64±11岁）妇女（97％）。尽管takotsubo心肌病发生在研究之前的20（13-39范围）个月，但大多数患者（88％）具有与心力衰竭相适应的持续症状（明尼苏达州心衰患者问卷调查中位数为13 [0-76]范围）以及运动测试的心脏限制（降低的峰值耗氧量，从24±1.3对比31±1.3 mL / kg / min，P <0.001；增加的VE / Vco2斜率，从31±1对比26±1，P = 0.002）。尽管左心室射血分数和血清生物标志物正常，但先前患有takotsubo心肌病的患者的心脏变形指数受损（心尖周向应变降低，-16±1.0对-23±1.5％，P <0.001；整体纵向应变，-17±1对-20±1％，P = 0.006），天然T1定位值增加（1264±10对1184±10 ms，P <0.001），心脏能量状态受损（磷酸肌酸/γ-腺苷三磷酸比，1.3±0.1对1.9±0.1，P <0.001）。结论与以前的看法相反，takotsubo心肌病具有长期的临床后果，包括与持续性亚临床心脏功能障碍相关的明显症状和功能障碍。综上所述，我们的发现表明，在takotsubo心肌病发生后，患者会出现持续的长期心力衰竭表型。临床试验注册网址：https：//clinicaltrials.gov。唯一标识符：NCT02989454。结论与以前的看法相反，takotsubo心肌病具有长期的临床后果，包括与持续性亚临床心脏功能障碍相关的明显症状和功能障碍。综上所述，我们的发现表明，在takotsubo心肌病发生后，患者会出现持续的长期心力衰竭表型。临床试验注册网址：https：//clinicaltrials.gov。唯一标识符：NCT02989454。结论与以前的看法相反，takotsubo心肌病具有长期的临床后果，包括与持续性亚临床心脏功能障碍相关的明显症状和功能障碍。综上所述，我们的发现表明，在takotsubo心肌病发生后，患者会出现持续的长期心力衰竭表型。临床试验注册网址：https：//clinicaltrials.gov。唯一标识符：NCT02989454。//clinicaltrials.gov。唯一标识符：NCT02989454。//clinicaltrials.gov。唯一标识符：NCT02989454。