JC42405

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さいぞうたけくま
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1 J Cardiol 2003 Oct; 424: Microvascular Stunning 1 Ampulla Cardiomyopathy With Delayed Recovery of Microvascular Stunning: A Case Report Kazutaka Tetsuro Tetsu Masashi Kenji Kihiro Kiyoshi AMAYA, MD SHIRAI, MD KODAMA, MT KASAO, MD TSUCHIDA, MD ASANO, MD INOUE, MD Abstract A 71-year old woman with schizophrenia was admitted to our hospital on November 26, 2002 under a diagnosis of acute myocardial infarction because of ST segment elevation in leads 2 5 and positive serum cardiac troponin T level. Emergent coronary angiography showed no significant stenosis, but left ventriculography demonstrated apical ballooning and basal hyperkinesis. The final diagnosis was ampulla cardiomyopathy. Myocardial contrast echocardiography during the acute phase revealed an echocontrast defect consistent with the area of apical ballooning. The condition improved gradually as determined by disappearance of the abnormal wall motion. The coronary flow reserve in the left anterior descending artery measured by transthoracic Doppler echocardiography was decreased at 1.5 in the acute phase and gradually recovered over a period of 3 months23 days, 1.9 ; 96 days, 2.9. Microvascular stunning defined as decreased coronary flow reserve was observed and recovery was delayed in this case compared with cases of myocardial stunning. These findings are of interest in evaluating the pathophysiology of ampulla cardiomyopathy. J Cardiol 2003 Oct; 424: Key Words Coronary circulation ampulla type Doppler ultrasound coronary flow reserve Coronary microcirculation microvascular stunning Myocardial stunning Contrast echocardiography 1 71 : Cardiovascular Disease Center, Tokyo Metropolitan Police Hospital, Tokyo Address for correspondence: AMAYA K, MD, Cardiovascular Disease Center, Tokyo Metropolitan Police Hospital, Fujimi 21041, Chiyoda-ku, Tokyo Manuscript received April 3, 2003; revised June 13, 2003 ; accepted June 16, 2003 MT medical technician 183

2 184 Table 1Laboratory findings on admission WBC RBC Hemoglobin Hematocrit Platelet count Total protein CK GOT GPT LDH CRP BUN Cr 16,400/l /l 13.7 g/dl 40.4% /l 6.6 mg/dl 1,111 IU/l 53 IU/l 14 IU/l 337 IU/l 0.5 mg/dl 16.9 mg/dl 0.54 mg/dl Na/Cl 139/105 meq/l K 3.6 meq/l Hemoglobin A 1c 5.5% BNP 133 pg/ml Myosin light chain 5.3 ng/ml Cardiac troponin T 1.65 ng/ml Blood Adrenaline 0.49 ng/ml Noradrenaline 2.7 ng/ml Dopamine 0.25 ng/ml Urea Adrenaline 19.4 ng/ml Noradrenaline 156 ng/ml Dopamine 240 ng/ml Fig. 1 Electrocardiogram on admission : : 30 /30 : ST 16,300/l 540 IU/lT : : 151 cm47 kg36.4c 156/94 mmhg 100/min Fig. 1: 88/minST X : 50% Table 1: : Figs. 2 AB Figs. 2CD µ 300 mg/ml Fig Fig. 4 Fig g/kg/min Figs Fig J Cardiol 2003 Oct; 424:

:Left coronary artery showing no significant

3 Microvascular Stunning 185 Fig. 2 Coronary angiograms in the acute phase A :Left coronary artery showing no significant stenosis. B : Right coronary artery showing no significant stenosis. C, D : Left ventriculogram showing apical ballooningc : Diastole. D : Systole. Cardiometrics FloWire 12 mg 1.7 ST 9 T 96T 2 1, J Cardiol 2003 Oct; 424:

recovering in the chronic phase right looning in the acute phase left Fig.

Right : Systole 通院中で発症前に睡眠薬の過服などが判明しておりが多量に検出されていた可能性も考えられる冠攣縮何らかの精神的ストレスが強まっていた可能性があの関与については

4 186 天谷白井兒玉ほか Fig. 3 Myocardial contrast echocardiograms revealing a contrast defect correlated with apical bal, and recovering in the chronic phase right looning in the acute phase left Fig. 4 Left ventriculograms taken 23 days later Left : Diastole. Right : Systole 通院中で発症前に睡眠薬の過服などが判明しておりが多量に検出されていた可能性も考えられる冠攣縮何らかの精神的ストレスが強まっていた可能性があの関与については慢性期にアセチルコリン負荷試験るまた急性期には血中尿中ノルアドレナリンがを施行したものの冠動脈の攣縮は誘発されなかった高値を示し慢性期には低下していたことから発症時ことより否定的であったに心臓交感神経活性の亢進があったことは十分に考えられる 5,6 冠微小循環の関与については急性期に冠血流予備しかし本例では急性期に強い不穏状態能が低下し慢性期には漸次回復したことより冠微小を伴っており副腎などの心臓外由来のカテコラミン循環障害は存在したものと考えられる今回用いた経 J Cardiol 2003 Oct; 42 4 :

reserve was low in the acute phase upper, but gradually recovered in the chronic phase middle, 23 days later; lower, 96 days

5 Microvascular Stunning 187 Fig. 5 Transthoracic Doppler echocardiograms showing coronary flow reserve in the left anterior descending artery Coronary flow reserve was low in the acute phase upper, but gradually recovered in the chronic phase middle, 23 days later; lower, 96 days later CFR coronary flow reserve Bolli 9 microvascular stunning microvascular stunning microvascular stunning Yanagi microvascular stunning Tl 12 Tl J Cardiol 2003 Oct; 424:

6 microvascular stunning microvascular stunning J Cardiol 2003 Oct; 424: : spasm stunned myocardiumin : 1990; pp : Stunned Myocardium ; 44 : : 1997; 45: : ; 35: : : 2001; 2 : : 2001; 33 : Hozumi T, Yoshida K, Akasaka T, Asami Y, Ogata Y, Takagi T, Kaji S, Kawamoto T, Ueda Y, Morioka S : Noninvasive assessment of coronary flow velocity and coronary flow velocity reserve in the left anterior descending coronary artery by Doppler echocardiography : Comparison with invasive technique. J Am Coll Cardiol 1998; 32 : Daimon M, Watanabe H, Yamagishi H, Muro T, Akioka K, Hirata K, Takeuchi K, Yoshikawa J: Physiologic assessment of coronary artery stenosis by coronary flow reserve measurements with transthoracic Doppler echocardiography: Comparison with exercise thallium-201 single photon emission computed tomography. J Am Coll Cardiol 2001; 37; Bolli R, Triana JF, Jeroudi MO : Prolonged impairment of coronary vasodilation after reversible ischemia: Evidence for microvascularstunning. Circ Res 1990 ; 67 : Yanagi S, Nagae K, Yoshida K, Matsumura Y, Nagashima E, Okada M, Ota T, Hirota K, Yoshikawa J : Evaluation of coronary flow reserve using Doppler guide wire in patients with ampulla cardiomyopathy : Three case reports. J Cardiol 2002; 39 : in Jpn with Eng abstr 11 : Stunned myocardium ; 30: : Ampulla or Amphora 2000 ; 48 : J Cardiol 2003 Oct; 424:

JC47101’ÓFC

JC47101’ÓFC J Cardiol 2006 Jan; 47 1 : 39 46 No Reflow 1 Takotsubo Cardiomyopathy Manifesting as No Reflow Pattern in Coronary Flow by Transthoracic Doppler Echocardiography and Prolonged Recovery of Regional Left