.
ÕÚıÚÔ ∞Ó·ÛÎfiËÛ˘
ª˘ÔηډÈÔ¿ıÂÈ· Tako-Tsubo: ∆Ô ™‡Ó‰ÚÔÌÔ Ù˘
“ƒ·ÁÈṲ̂Ó˘ K·Ú‰È¿˜”
™¶ÀƒI¢ø¡ ∫OÀ§OYƒ∏™, ™ø∫ƒA∆∏™ ¶∞™∆ƒøªA™, ¢∏ª∏∆ƒπO™ ™∞∫∂§§∞ƒπOÀ,
£∂O¢øƒO™ ∫ƒ∞∆∏ª∂¡√™, ¶§OÀ∆∞ƒÃO™ ¶π¶∂ƒ√¶OÀ§O™, ∞¡∆ø¡∏™ ™. ª∞¡ø§∏™
.
∏
¢È‡ı˘ÓÛË
EÈÎÔÈÓˆÓ›·˜:
™˘Ú›‰ˆÓ KÔ˘ÏÔ‡Ú˘
K¤ÎÚÔÔ˜ 64, M·ÚÔ‡ÛÈ
151 25 Aı‹Ó·
e-mail:
spyridon.koulouris@gmail
.com
Ì˘ÔηډÈÔ¿ıÂÈ· Tako-Tsubo
(TTC), Â›Ó·È ÌÈ· Û¿ÓÈ· ÎÏÈÓÈ΋
ÔÓÙfiÙËÙ· Ô˘ ÌÈÌÂ›Ù·È ÙÔ Ô͇ ÛÙÂÊ·ÓÈ·›Ô Û‡Ó‰ÚÔÌÔ ·ÏÏ¿ ÔÏϤ˜ ÊÔÚ¤˜
˘ԉȷÁÈÁÓÒÛÎÂÙ·È. ∆· ·ÚÈ· ¯·Ú·ÎÙËÚÈÛÙÈο Ù˘ ›ӷÈ: ÔÈÛıÔÛÙÂÚÓÈÎfi ¿ÏÁÔ˜,
ÈÛ¯·ÈÌÈΤ˜ ·ÏÏÔÈÒÛÂȘ ÛÙÔ ËÏÂÎÙÚÔηډÈÔÁÚ¿ÊËÌ· (∏∫°), ÂÏ·ÊÚ¿ ·‡ÍËÛË ÙˆÓ
ηډȷÎÒÓ ÂÓ˙‡ÌˆÓ Î·È ÙÌËÌ·ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ù˘ ÎÈÓËÙÈÎfiÙËÙ·˜ Ù˘ ·ÚÈÛÙÂÚ‹˜
ÎÔÈÏ›·˜. ¶ÚÒÙË ÊÔÚ¿ ÂÚÈÁÚ¿ÊËÎÂ ·fi
ÙÔ˘˜ Hikaru Sato Î·È Û˘Ó.1 ÛÙȘ ·Ú¯¤˜ Ù˘
ÚÔËÁÔ‡ÌÂÓ˘ ‰ÂηÂÙ›·˜ ÛÙËÓ π·ˆÓ›·.
∏ ÔÓÔÌ·Û›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÔÊ›ÏÂÙ·È
ÛÙÔ ÁÂÁÔÓfi˜ fiÙÈ ÛÙËÓ ÎÏ·ÛÛÈ΋ ÌÔÚÊ‹
Ù˘ ÓfiÛÔ˘ Ë ·ÚÈÛÙÂÚ‹ ÎÔÈÏ›· ÛÙËÓ Û˘ÛÙÔÏ‹ ¤¯ÂÈ ÙÔ Û¯‹Ì· ÙÔ˘ “tako-tsubo”, ÂÓfi˜
‰Ô¯Â›Ô˘ ÁÈ· ·Á›‰Â˘ÛË ¯Ù·Ô‰ÈÒÓ Ô˘
¯ÚËÛÈÌÔÔÈÂ›Ù·È ÛÙËÓ π·ˆÓ›· Î·È ¤¯ÂÈ
ÛÙÂÓfi ·˘¯¤Ó· Î·È Â˘Ú›· ΢ÎÏÈ΋ ‚¿ÛË
(∂ÈÎfiÓ· 1). ∞Ú¯Èο ˘‹Ú¯Â Ë ·ÓÙ›ÏË„Ë
fiÙÈ ÙÔ Û‡Ó‰ÚÔÌÔ ÂÌÊ·Ó›˙ÔÓÙ·Ó ·ÔÎÏÂÈÛÙÈο ÛÙÔ˘˜ π¿ˆÓ˜ ÏfiÁˆ οÔÈÔ˘
¿ÁÓˆÛÙÔ˘ ÁÂÓÂÙÈÎÔ‡ ‹ ÂÚÈ‚·ÏÏÔÓÙÈÎÔ‡
ÚԉȷıÂÛÈÎÔ‡ ·Ú¿ÁÔÓÙ·.2 ∆ËÓ ÙÂÏÂ˘Ù·›· ‰ÂηÂÙ›· fï˜ ¤¯Ô˘Ó ÂÚÈÁÚ·Ê›
ÔÏÏ¿ ÂÚÈÛÙ·ÙÈο ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÁÎÔÛÌ›ˆ˜ ηٷÚÚ›ÙÔÓÙ·˜ ÙË ıˆڛ· Ù˘
ÁˆÁÚ·ÊÈο ·ÔÌÔӈ̤Ó˘ ÓfiÛÔ˘. ∂›Û˘, ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› ‰È¿ÊÔÚ˜ ÌÔÚʤ˜
ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Ô˘ ÂÚÈÏ¿Ì‚·Ó·Ó ‰È¿ÊÔÚ· ÙÌ‹Ì·Ù· ÙÔ˘ ÙÔȯÒÌ·ÙÔ˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜. ¢È¿ÊÔÚ· ÔÓfiÌ·Ù· ¤¯Ô˘Ó
ηٿ ηÈÚÔ‡˜ ‰Ôı› ÛÙÔ Û‡Ó‰ÚÔÌÔ ·˘Ùfi
(Ì˘ÔηډÈÔ¿ıÂÈ· ·fi stress, Ì˘ÔηډÈÔ¿ıÂÈ· “ampulla”, ·ÚÔ‰È΋ ·Ó·‰È·ÌfiÚʈÛË Ù˘ ÎÔÚ˘Ê‹˜ Ù˘ ·ÚÈÛÙÂÚ‹˜
ÎÔÈÏ›·˜ “‰›ÎËÓ Ì·ÏÔÓÈÔ‡’’, Û‡Ó‰ÚÔÌÔ
“Ú·ÁÈṲ̂Ó˘ ηډȿ˜”, Ó¢ÚÔÁÂÓ‹˜ Ì˘Ôηډȷ΋ ·ÔÏËÍ›·). ∆ÂÏÈο, ÙÔ 2006
Ù·ÍÈÓÔÌ‹ıËΠÛÙÔÓ Î·Ù¿ÏÔÁÔ ÙˆÓ Â›ÎÙËÙˆÓ Ì˘ÔηډÈÔ·ıÂÈÒÓ ˘fi ÙÔ fiÓÔÌ·
“Ì˘ÔηډÈÔ¿ıÂÈ· ·fi stress”.3 ŒÓ· ÛËÌ·ÓÙÈÎfi ÛÙÚÂÛÛÔÁfiÓÔ ÂÚ¤ıÈÛÌ· (Ê˘ÛÈÎfi
‹ Û˘Ó·ÈÛıËÌ·ÙÈÎfi) ÚÔηÏ› ÙËÓ ¤Ó·ÚÍË
ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ·Ó Î·È ‰ÂÓ Î·Ù·ÁÚ¿ÊÂÙ·È ÛÙÔ ÈÛÙÔÚÈÎfi fiÏˆÓ ÙˆÓ ·ÛıÂÓÒÓ. ∏
ÔÚ›· Ù˘ ÓfiÛÔ˘ Â›Ó·È Î·ÏÔ‹ı˘ ηÈ
ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛÂˆÓ ·Ó·Ì¤ÓÂÙ·È Ï‹Ú˘ ·ÔηٿÛÙ·ÛË Û ÌÂÚÈΤ˜ ‚‰ÔÌ¿‰Â˜.
∂ȉËÌÈÔÏÔÁ›·
∏ ·ÎÚÈ‚‹˜ Â›ÙˆÛË Ù˘ ÓfiÛÔ˘ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË. ™ÙËÓ π·ˆÓ›· ˘ÔÏÔÁ›˙ÂÙ·È
fiÙÈ ·ÓÙÈÚÔÛˆ‡ÂÈ ÙÔ 1-2% ÙˆÓ ÂÈÛ·ÁˆÁÒÓ ÛÙÔ ¡ÔÛÔÎÔÌÂ›Ô ÏfiÁˆ ÔÈÛıÔÛÙÂÚÓÈÎÔ‡ ¿ÏÁÔ˘˜ Î·È ‰˘Ó·ÌÈÎÒÓ ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈÎÒÓ ·ÏÏÔÈÒÛˆÓ. 4 ™ÙȘ
∏.¶.∞ ˘ÔÏÔÁ›˙ÂÙ·È fiÙÈ ÙÔ 2-2,2% ÙˆÓ
·ÛıÂÓÒÓ Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È ÛÙÔ ∆Ì‹Ì·
∂ÂÈÁfiÓÙˆÓ Ì ÂÈÎfiÓ· ·ÛÙ·ıÔ‡˜ ÛÙËı¿Á¯Ë˜ ‹ ÔͤԘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ Ì ·Ó¿Û·ÛË ÙÔ˘ ST (STEMI) ÂͤگÔÓÙ·È Ì ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘
.
∂ÈÎfiÓ· 1. ∆Ô ‰Ô¯Â›Ô Ô˘ ¯ÚËÛÈÌÔÔÈÔ‡Ó ÔÈ π¿ˆÓ˜ ÁÈ· ÙËÓ ·Á›‰Â˘ÛË ¯Ù·Ô‰ÈÒÓ (Tako – tsubo pot).
Tako Tsubo.5,6 º·›ÓÂÙ·È fï˜ fiÙÈ ·˘Ù¿ Ù· ÔÛÔÛÙ¿
˘ÔÂÎÙÈÌÔ‡Ó ÙËÓ Ú·ÁÌ·ÙÈ΋ Â›ÙˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·ÊÔ‡ Ì ÙȘ Û‡Á¯ÚÔÓ˜ Ù¯ÓÈΤ˜ ·ÓÙÈÌÂÙÒÈÛ˘
ÙˆÓ ÔͤˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ Û˘Ó‰ÚfiÌˆÓ (ıÚÔÌ‚fiÏ˘ÛË
Î·È ÚˆÙÔÁÂÓ‹˜ ·ÁÁÂÈÔÏ·ÛÙÈ΋), Ë ‰È¿ÁÓˆÛË ÙÔ˘
Û˘Ó‰ÚfiÌÔ˘ ‰È·Ê‡ÁÂÈ Û ÔÏϤ˜ ÂÚÈÙÒÛÂȘ. ∂›Ó·È
¯·Ú·ÎÙËÚÈÛÙÈÎfi fiÙÈ ·fi ÙfiÙ Ô˘ ÙÔ Û‡Ó‰ÚÔÌÔ ¤ÁÈÓÂ
¢ڤˆ˜ ÁÓˆÛÙfi Î·È ıÂÛ›ÛÙËÎ·Ó Û˘ÁÎÂÎÚÈ̤ӷ ‰È·ÁÓˆÛÙÈο ÎÚÈÙ‹ÚÈ· ·Ó·Ê¤ÚÔÓÙ·È Û ‰È¿ÊÔÚ˜ ÌÂϤÙ˜ ÌÂÁ·Ï‡ÙÂÚ· ÔÛÔÛÙ¿ ÂÌÊ¿ÓÈÛ˘ (.¯. Û ÚfiÛÊ·ÙË ÌÂϤÙË ÙÔ˘ Facciorusso Î·È Û˘Ó.7 ·Ó·Ê¤ÚÂÙ·È
Â›ÙˆÛË Ù˘ ÓfiÛÔ˘ 4,78%).
∂ÈϤÔÓ, ÌÂϤÙ˜ Û ÂȉÈΤ˜ ÏËı˘ÛÌȷΤ˜ ÔÌ¿‰Â˜ ¤¯Ô˘Ó ‰Â›ÍÂÈ Ôχ ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿ ÂÌÊ¿ÓÈÛ˘ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ™Â ÌÂϤÙË ÙˆÓ Park Î·È Û˘Ó. 8
‚Ú¤ıËΠfiÙÈ ÛÙÔ 33% ÙˆÓ ·ÛıÂÓÒÓ Ô˘ ‰È·ÎÔÌ›ÛÙËÎ·Ó ÛÙËÓ ªÔÓ¿‰· ∂ÓÙ·ÙÈ΋˜ £ÂÚ·›·˜ Ì ÌË Î·Ú‰ÈÔÏÔÁÈÎfi Úfi‚ÏËÌ· (·Ó·Ó¢ÛÙÈ΋ ·ÓÂ¿ÚÎÂÈ· ‹
Û‹„Ë) ‰È·ÁÓÒÛÙËΠTTC. ™Â ÌÈ· ÌÂϤÙË ÙˆÓ Hartting Î·È Û˘Ó. 9 ‰È·ÈÛÙÒıËΠ·˘ÍË̤ÓË Â›ÙˆÛË
¯ÚfiÓÈ·˜ ·ÔÊÚ·ÎÙÈ΋˜ Ó¢ÌÔÓÔ¿ıÂÈ·˜ ‹ ‚ÚÔÁ¯ÈÎÔ‡ ¿ÛıÌ·ÙÔ˜ Û 32 ·ÛıÂÓ›˜ Ô˘ ·Ó·‰ÚÔÌÈο ‰È·ÁÓÒÛÙËΠTTC. ∂›Û˘, ¤¯Ô˘Ó ·Ó·ÊÂÚı› ˘„ËÏ¿ ÔÛÔÛÙ¿ ˘¤ÚÙ·Û˘ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì TTC (76% Û‡Ìʈӷ Ì ÌÈ· ÌÂϤÙË10). ŸÏ· ·˘Ù¿ Ù· Â˘Ú‹Ì·Ù· ÂÓÈÛ¯‡Ô˘Ó ÙËÓ ¿Ô„Ë fiÙÈ ÌÈ· ˘ÂÚ‚ÔÏÈ΋ ¤ÎÎÚÈÛË Î·Ù¯ÔÏ·ÌÈÓÒÓ Ú¤ÂÈ Ó· ‰È·‰Ú·Ì·Ù›˙ÂÈ ‚·ÛÈÎfi ÚfiÏÔ
ÛÙËÓ ·ıÔÁ¤ÓÂÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ™ÙȘ ÂÚÈÛÛfiÙÂÚ˜
ÛÂÈÚ¤˜ ·ÛıÂÓÒÓ ·Ó·Ê¤ÚÂÙ·È ÌÂÁ·Ï‡ÙÂÚË Â›ÙˆÛË
ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÛÙȘ Á˘Ó·›Î˜ Î·È ÛÙÔ˘˜ ÈÔ ËÏÈÎȈ̤ÓÔ˘˜ Ì ÙȘ ÌÂÙÂÌÌËÓÔ·˘ÛȷΤ˜ Á˘Ó·›Î˜ Ó· ·Ô-
ÙÂÏÔ‡Ó ÙÔ 90% ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜
ÌÂϤÙ˜.11-13 ¶·ÚfiÏ· ·˘Ù¿, ˘¿Ú¯Ô˘Ó οÔȘ ÂÍ·ÈÚ¤ÛÂȘ ηıÒ˜ ÔÈ ÚÔÂÌÌËÓÔ·˘ÛȷΤ˜ Á˘Ó·›Î˜ ÂÌÊ·Ó›˙Ô˘Ó Û ÌÂÁ·Ï‡ÙÂÚË Û˘¯ÓfiÙËÙ· ÙËÓ ÌÔÚÊ‹ Ù˘
ÓfiÛÔ˘ Ô˘ ·Ê‹ÓÂÈ ¿ıÈÎÙË ÙËÓ ÎÔÚ˘Ê‹ Ù˘ ·ÚÈÛÙÂÚ‹˜
ÎÔÈÏ›·˜14 ÂÓÒ ÔÈ ¿ÓÙÚ˜ ÂÌÊ·Ó›˙Ô˘Ó Û˘¯ÓfiÙÂÚ· ÙÔ
Û‡Ó‰ÚÔÌÔ ÌÂÙ¿ ·fi Ê˘ÛÈÎfi Î·È fi¯È „˘¯ÈÎfi ÛÙÚÂÛÛÔÁfiÓÔ ÂÚ¤ıÈÛÌ·.15 ∏ ·ÈÙ›· Ù˘ ÌÂÁ·Ï‡ÙÂÚ˘ Û˘¯ÓfiÙËÙ·˜ ÂÌÊ¿ÓÈÛ˘ ÛÙȘ Á˘Ó·›Î˜ ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË ·Ó
Î·È Ë ¤ÏÏÂÈ„Ë ÔÈÛÙÚÔÁfiÓˆÓ ÛÙȘ ÌÂÙÂÌÌËÓÔ·˘ÛȷΤ˜ Á˘Ó·›Î˜ Ê·›ÓÂÙ·È Ó· ·›˙ÂÈ Î¿ÔÈÔ ÚfiÏÔ ÛÙËÓ
·ıÔÁ¤ÓÂÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘. ∏ ‡·ÚÍË Î¿ÔÈÔ˘ Û˘Ó·ÈÛıËÌ·ÙÈÎÔ‡ ÛÙÚÂÛÛÔÁfiÓÔ˘ ÂÚÂı›ÛÌ·ÙÔ˜ Ê·›ÓÂÙ·È
Ó· Â›Ó·È ÙÔ ÂÎÏ˘ÙÈÎfi ·›ÙÈÔ ÛÙ· 2/3 ÙˆÓ ÂÚÈÙÒÛˆÓ.
∞Ó Î·È Ù˘Èο Ë Ì˘Ôηډȷ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ·ÎÔÏÔ˘ı› ¤Ó· Ô͇ „˘¯ÔÏÔÁÈÎfi ÛÙÚÂÛÛÔÁfiÓÔ ÂÚ¤ıÈÛÌ·
(·ÚÔÛ‰fiÎËÙÔ˜ ı¿Ó·ÙÔ˜ ÛÙÂÓÔ‡ Û˘ÁÁÂÓÔ‡˜, ·ÓÙÈ·Ú¿ıÂÛË Ì οÔÈÔ ÚfiÛˆÔ, Êfi‚Ô˜ ÚÈÓ ·fi οÔÈ· Â¤Ì‚·ÛË ÎÏ.), ¤Ó· Ê˘ÛÈÎfi ÛÙÚÂÛÛÔÁfiÓÔ ÂÚ¤ıÈÛÌ· (.¯. Ó¢ÌÔÓÈ΋ ÓfiÛÔ˜, Û‹„Ë, ÙÚ·‡Ì· ‹ ÎÚ·ÓÈÔÂÁÎÂÊ·ÏÈ΋ οΈÛË) ¤¯ÂÈ ÙȘ ›‰È˜ Èı·ÓfiÙËÙ˜
Ó· Â›Ó·È ÙÔ ÂÎÏ˘ÙÈÎfi ·›ÙÈÔ. ∏ ∫·˘Î¿ÛÈ· Ê˘Ï‹ ›ӷÈ
ÈÔ Â˘¿ÏˆÙË ÛÙÔ Û˘Ó·ÈÛıËÌ·ÙÈÎfi stress ·fi fiÙÈ ÔÈ
∞ÛÈ¿Ù˜.16 ∂›Ó·È fï˜ ¯·Ú·ÎÙËÚÈÛÙÈÎfi fiÙÈ ÛÙÔ 1/3
ÙˆÓ ÂÚÈÙÒÛÂˆÓ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ‰ÂÓ ·ÓȯÓ‡ÂÙ·È
ÛÙÔ ÈÛÙÔÚÈÎfi Ë ‡·ÚÍË ÛÙÚÂÛÛÔÁfiÓÔ˘ ÂÚÂı›ÛÌ·ÙÔ˜
Î·È Î·Ù¿ Û˘Ó¤ÂÈ· Ë ·Ô˘Û›· Û·ÊÔ‡˜ ÂÎÏ˘ÙÈÎÔ‡ ·ÈÙ›Ô˘ ‰ÂÓ ·ÔÎÏ›ÂÈ ÙË ‰È¿ÁÓˆÛË ÙÔ˘ TTC.
¶·ıÔÁ¤ÓÂÈ·
√È ·ıÔÁÂÓÂÙÈÎÔ› Ì˯·ÓÈÛÌÔ› ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·Ú·Ì¤ÓÔ˘Ó ÂÓ ÔÏÏÔ›˜ ¿ÁÓˆÛÙÔÈ. Œ¯Ô˘Ó ηٿ ηÈÚÔ‡˜
ÚÔÙ·ı› ‰È¿ÊÔÚ˜ ıˆڛ˜. ∏ ÌÂÁ¿ÏË ¤ÎÎÚÈÛË Î·Ù¯ÔÏ·ÌÈÓÒÓ Û·ÊÒ˜ ‰È·‰Ú·Ì·Ù›˙ÂÈ ÛËÌ·ÓÙÈÎfi ÚfiÏÔ
·ÏÏ¿ Ë ·ÎÚÈ‚‹˜ ‰Ú¿ÛË Ù˘ ¿Óˆ ÛÙÔ Ì˘ÔοډÈÔ ‰ÂÓ
¤¯ÂÈ ·ÔÛ·ÊËÓÈÛÙ›. √È Ibanez Î·È Û˘Ó. ˘ÔÛÙ‹ÚÈÍ·Ó
ÙËÓ ‡·ÚÍË ·ıËÚÔÛÎÏËÚ˘ÓÙÈ΋˜ ÓfiÛÔ˘ Ì ڋÍË Ͽη˜ Ô˘ Ô‰ËÁ› Û ÔÍ›· ÈÛ¯·ÈÌ›·.17 ŸÏÔÈ ÔÈ ·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘ÛÈ¿ÛÙËÎ·Ó ·fi ÙÔ˘˜ Û˘ÁÎÂÎÚÈ̤ÓÔ˘˜
ÂÚ¢ÓËÙ¤˜ ·ÚÔ˘Û›·˙·Ó ·ÚfiÌÔÈ· ÌÔÚÊÔÏÔÁ›· ÙˆÓ
ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ Ì ÌÂÁ¿ÏÔ˘ Ì‹ÎÔ˘˜ ÚfiÛıÈÔ
ηÙÈfiÓÙ· ÎÏ¿‰Ô (LAD) Ô˘ ·Ó·Î¿ÌÙÂÈ Á‡Úˆ ·fi
ÙËÓ ÎÔÚ˘Ê‹ Ù˘ ηډȿ˜ ÂÍËÁÒÓÙ·˜ ¤ÙÛÈ Î·È ÙËÓ ·ÎÈÓËÛ›· Ù˘ ÎÔÚ˘Ê‹˜ Ô˘ ·Ú·ÙËÚÂ›Ù·È ÛÙÔ Û‡Ó‰ÚÔÌÔ.
¶·ÚfiÏ· ·˘Ù¿, Ë ·ÚÔ˘Û›· ¤ÛÙˆ Î·È ·ÚÔ‰È΋˜ Ì˘Ôηډȷ΋˜ ÈÛ¯·ÈÌ›·˜ ··ÈÙ› ÙËÓ ‡·ÚÍË ıÚfiÌ‚Ô˘
ÂÓÙfi˜ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ οÙÈ Ô˘ ÔÙ¤ ‰ÂÓ
¤¯ÂÈ ‚ÚÂı› Û ·ÛıÂÓ›˜ Ì TTC. ∂›Û˘, Ë ·ÚÔ˘Û›·
ÌÂÁ¿ÏÔ˘ Ì‹ÎÔ˘˜ LAD ‰ÂÓ ¤¯ÂÈ ÂÚÈÁÚ·Ê› ·fi ¿ÏÏÔ˘˜ ÂÚ¢ÓËÙ¤˜.
.
™‡Ìʈӷ Ì ÌÈ· ¿ÏÏË ıˆڛ· ÚÔÙ›ÓÂÙ·È Ô
Û·ÛÌfi˜ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ˆ˜ ÂÎÏ˘ÙÈÎfi ·›ÙÈÔ ÙÔ˘
Û˘Ó‰ÚfiÌÔ˘. √ Û·ÛÌfi˜ Ú¤ÂÈ Ó· Û˘Ì‚·›ÓÂÈ Ù·˘Ùfi¯ÚÔÓ· Û ÔÏÏ¿ ·ÁÁ›· ÚÔÎÂÈ̤ÓÔ˘ Ó· ‰ÈηÈÔÏÔÁËıÔ‡Ó ÔÈ ‰È·ÊÔÚÂÙÈΤ˜ ÂÓÙÔ›ÛÂȘ ÙˆÓ ˘ÔÎÈÓËÛÈÒÓ
ÛÙ· ÙÔȯÒÌ·Ù· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜. ¶Ú¿ÁÌ·ÙÈ, οÔÈÔÈ ÂÚ¢ÓËÙ¤˜ ηÙfiÚıˆÛ·Ó Ó· ÚÔηϤÛÔ˘Ó Û·ÛÌfi Û ÔÏÏ¿ ·ÁÁ›· Ù·˘Ùfi¯ÚÔÓ· Û ·ÛıÂÓ›˜ ÌÂ
TTC11,18 ÂÓÒ ·ÓÙ›ıÂÙ· ¿ÏÏÔÈ ·¤Ù˘¯·Ó.19,20 ∂ÈϤÔÓ, Ë Î·Ù¿ ÚÔ˘Ù›Ó· ¯ÔÚ‹ÁËÛË ÓÈÙÚˆ‰ÒÓ ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ô˘ ·ÚÔ˘ÛÈ¿˙ÔÓÙ·È Ì ÔÈÛıÔÛÙÂÚÓÈÎfi ¿ÏÁÔ˜
οÓÂÈ ÈÔ ‰‡ÛÎÔÏË ÙËÓ ‰ÈÂÚ‡ÓËÛË ÙÔ˘ Û˘ÁÎÂÎÚÈ̤ÓÔ˘ Ì˯·ÓÈÛÌÔ‡. ø˜ ¿ÏÏË Èı·Ó‹ ·ÈÙ›· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ·Ó·Ê¤ÚÂÙ·È Ë ÌÈÎÚÔ·ÁÁÂȷ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ηÈ
Ô Û·ÛÌfi˜ ÙˆÓ ÌÈÎÚÒÓ ·ÁÁ›ˆÓ. √È Elsber Î·È Û˘Ó.21
·Ó·Ê¤ÚÔ˘Ó ·ÓÒÌ·ÏË ·ÈÌ¿ÙˆÛË Î·Ù¿ TIMI (¤Ó·˜ ·ÁÁÂÈÔÁÚ·ÊÈÎfi˜ ‰Â›ÎÙ˘ ·ÈÌ¿ÙˆÛ˘ ÙÔ˘ Ì˘Ôηډ›Ô˘)
ÛÙÔ 69% ÙˆÓ ·ÛıÂÓÒÓ Ì TTC. ∂ÈÚfiÛıÂÙ·, ÔÈ
Sadamatsu Î·È Û˘Ó.22 ¤‰ÂÈÍ·Ó ÌÂȈ̤ÓË ÛÙÂÊ·ÓÈ·›·
Âʉڛ· ÚÔ‹˜ ¯ÚËÛÈÌÔÔÈÒÓÙ·˜ ¤Ó· ÂȉÈÎfi Û‡ÚÌ·
ηıÔ‰ËÁÔ‡ÌÂÓÔ Ì Doppler ÛÙÔ˘˜ ·ÛıÂÓ›˜ ÙÔ˘˜ ÌÂ
∆∆C. ∞ÓÙ›ıÂÙ·, ÔÈ Yoshida Î·È Û˘Ó.23 ‚Ú‹Î·Ó ÌfiÓÔ
‹ÈÔ ÂÚÈÔÚÈÛÌfi ÛÙËÓ ·ÈÌ¿ÙˆÛË Î·Ù¿ ÙË ‰ÔÎÈÌ·Û›·
Ì ÛÈÓıËÚÔÁÚ¿ÊËÌ· Ì˘Ôηډ›Ô˘ Ì Thallium 201
ÛÙÔ˘˜ ·ÛıÂÓ›˜ ÙÔ˘˜ Ô˘ ·ÚÔ˘Û›·˙·Ó ÙÔ Û‡Ó‰ÚÔÌÔ
ÂÓÒ ‹Ù·Ó Û·ÊÒ˜ ÌÂȈ̤ÓË Ë ÚfiÛÏË„Ë Ù˘ F-8 ÊÏÔ˘ÔÚÔ‰ÂÛÔ͢ÁÏ˘Îfi˙˘ ·fi ÙË ÎÔÚ˘Ê‹ Ù˘ ·ÚÈÛÙÂÚ‹˜
ÎÔÈÏ›·˜ ÁÂÁÔÓfi˜ Ô˘ ‰Â›¯ÓÂÈ ÌÂÙ·‚ÔÏÈÎfi ¤ÏÏÂÈÌÌ·
·Ú¿ ¤ÏÏÂÈÌÌ· ·ÈÌ¿ÙˆÛ˘. ŒÙÛÈ, ·Ú·Ì¤ÓÂÈ ·‰È¢ÎÚ›ÓÈÛÙÔ ·Ó Ë ‰È·Ù·Ú·¯‹ ÙˆÓ ÌÈÎÚÒÓ ·ÁÁ›ˆÓ ·›˙ÂÈ
‚·ÛÈÎfi ÚfiÏÔ ÛÙËÓ ·ıÔÁ¤ÓÂÈ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ‹ ·Ó
·ÔÙÂÏ› Û˘ÓÔ‰fi ‡ÚËÌ· ÌÈ·˜ ÈÔ ÂÎÙÂٷ̤Ó˘ Ì˘Ôηډȷ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜.
∏ ˘fiıÂÛË Ù˘ ÔÍ›·˜ Ì˘Ôηډ›Ùȉ·˜ ˆ˜ ·›ÙÈÔ
Ù˘ Ì˘Ôηډȷ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ‰ÂÓ ÂȂ‚·ÈÒıËΠ·fi ÌÂϤÙ˜ Ô˘ ‰ÈÂÓÂÚÁ‹ıËÎ·Ó Ì˘ÔηډȷΤ˜
‚ÈÔ„›Â˜.24,25 ∂Ó‰ÂÈÎÙÈΤ˜ Ù˘ ·¢ı›·˜ ÙÔÍÈ΋˜ ‰Ú¿Û˘ ÙˆÓ Î·Ù¯ÔÏ·ÌÈÓÒÓ Â›Ó·È ÔÈ ·Ú·ÙËÚÔ‡ÌÂÓ˜
‚Ï¿‚˜ Û ÈÛÙÈÎfi Â›‰Ô. ∏ ÚÒÙË ·Ó·ÊÔÚ¿ ÁÈ· ·˘ÍË̤ӷ Â›‰· ηÙ¯ÔÏ·ÌÈÓÒÓ ÛÙÔ Ï¿ÛÌ· ·ÛıÂÓÒÓ Ì TTC ‹Ù·Ó ·fi ÙÔ˘˜ Wittstein Î·È Û˘Ó24 ÂÓÒ
Û ÌÈ· ÚfiÛÊ·ÙË ÌÂϤÙË ÂȂ‚·ÈÒıËÎ·Ó Ù· Â˘Ú‹Ì·Ù· ·˘Ù¿ ηıÒ˜ ‰È·ÈÛÙÒıËΠ·˘ÍË̤ÓË ÙÔÈ΋
·ÂÏ¢ı¤ÚˆÛË Î·Ù¯ÔÏ·ÌÈÓÒÓ ·fi ‰Â›ÁÌ·Ù· ·›Ì·ÙÔ˜ Ô˘ ÂÏ‹ÊıËÛ·Ó ·fi ÙËÓ ·ÔÚÙÈ΋ Ú›˙· Î·È ÙÔÓ
ÛÙÂÊ·ÓÈ·›Ô ÎfiÏÔ.26 ™Â ÌÂϤÙ˜ Ì ÂÈÚ·Ì·Ùfi˙ˆ·
·Ú·ÙËÚ‹ıËΠ·˘ÍË̤ÓË ˘ÎÓfiÙËÙ· ‚ – ·‰ÚÂÓÂÚÁÈÎÒÓ ˘Ô‰Ô¯¤ˆÓ ÛÙËÓ ÎÔÚ˘Ê‹ Ù˘ ηډȿ˜.27 ∞Ó Î¿ÙÈ
Ù¤ÙÔÈÔ ÈÛ¯‡ÂÈ Î·È ÁÈ· ÙËÓ ·ÓıÚÒÈÓË Î·Ú‰È¿, ÌÔÚ›
οÏÏÈÛÙ· Ó· ÂÍËÁ‹ÛÂÈ ÙËÓ ·˘ÍË̤ÓË Â˘·ÈÛıËÛ›· Ù˘
ÎÔÚ˘Ê‹˜ Ù˘ ηډȿ˜ ÛÙËÓ ¿ÌÂÛË ÙÔÍÈ΋ Â›‰Ú·ÛË
ÙˆÓ Î·Ù¯ÔÏ·ÌÈÓÒÓ, οÙÈ Ô˘ ̤ÓÂÈ fï˜ Ó· ·Ô‰Âȯı›. ∞fi ÙÔ˘˜ Lyon Î·È Û˘Ó28 ÚÔÙ¿ıËΠ¤Ó· ÌÔÓÙ¤ÏÔ Ô˘ ÂÚÈÂÏ¿Ì‚·Ó ÌÈ· ·ÏÏ·Á‹ ÛÙËÓ ÂÓ‰Ô΢ÙÙ¿ÚÈ·
ÌÂÙ¿‰ÔÛË ÙÔ˘ ÂÚÂı›ÛÌ·ÙÔ˜ ÛÙ· Ì˘Ôηډȷο ·ÙÙ·Ú· ·fi ÙȘ ÚˆÙ½Ó˜ Gs ÛÙȘ ·ÓÙ›ÛÙÔȯ˜ Gi ̤ۈ
ÙˆÓ ‚2 ·‰ÚÂÓÂÚÁÈÎÒÓ ˘Ô‰Ô¯¤ˆÓ, ÚÔηÏÒÓÙ·˜ ¤ÙÛÈ
ÌÈ· ·ÚÔ‰È΋ ·ÚÓËÙÈ΋ ÈÓfiÙÚÔË ‰Ú¿ÛË. ∞˘Ù‹ Ë ˘fiıÂÛË ˆÛÙfiÛÔ ‰ÂÓ ¤¯ÂÈ ÂȂ‚·Èˆı› ·ÎfiÌË. ŒÓ·˜
¿ÏÏÔ˜ ·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ Ô˘ ÂÌϤÎÂÙ·È
ÛÙËÓ ÂÌÊ¿ÓÈÛË ÙÔ˘ TTC Â›Ó·È Ë ÂÌÊ¿ÓÈÛË ·ÚÔ‰È΋˜
·fiÊڷ͢ ÙÔ˘ ¯ÒÚÔ˘ ÂÍfi‰Ô˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜.29 ™‡Ìʈӷ Ì ÙËÓ ¿Ô„Ë ·˘Ù‹ ËÏÈÎȈ̤Ó˜ Á˘Ó·›Î˜ Ô˘ Û˘¯Ó¿ ¤¯Ô˘Ó ÛÈÁÌÔÂȉ¤˜ ÌÂÛÔÎÔÈÏÈ·Îfi
‰È¿ÊÚ·ÁÌ· ÌÔÚ› Ó· ÂÌÊ·Ó›ÛÔ˘Ó ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡
·fiÊÚ·ÍË Î¿Ùˆ ·fi ÙËÓ Â›‰Ú·ÛË ·˘ÍËÌ¤ÓˆÓ ÂÈ¤‰ˆÓ ηÙ¯ÔÏ·ÌÈÓÒÓ, Ì ·ÔÙ¤ÏÂÛÌ· Ó· ÚÔηÏÂ›Ù·È ÈÛ¯·ÈÌ›· Ù˘ ÎÔÚ˘Ê‹˜ ÏfiÁˆ ·˘ÍË̤Ó˘ ÙÔȯˆÌ·ÙÈ΋˜ Ù¿Û˘. ∞Ó Î·È Î·Ù¿ ÙË ¯ÔÚ‹ÁËÛË ‰Ô‚Ô˘Ù·Ì›Ó˘
·Ó··Ú‹¯ıË ÛËÌ·ÓÙÈ΋ ÂÓ‰ÔÎÔÈÏÔÙÈ΋ ÎÏ›ÛË ›ÂÛ˘
Û οÔÈÔ˘˜ ·ÛıÂÓ›˜ Ì TTC, Ô Ì˯·ÓÈÛÌfi˜ ·˘Ùfi˜
‰ÂÓ ÌÔÚ› Ó· ÂÍËÁ‹ÛÂÈ ÙȘ ÏÈÁÔÛÙ¤˜ ·Ú·ÏÏ·Á¤˜ Ù˘
ÓfiÛÔ˘ ÛÙȘ Ôԛ˜ ‰ÂÓ ·Ú·ÙËÚÂ›Ù·È ÚÔÛ‚ÔÏ‹ Ù˘
ÎÔÚ˘Ê‹˜. ªÔÏ·Ù·‡Ù·, ÌÔÚ› Ó· ·ÓÙÈÚÔÛˆ‡ÂÈ
ÌÈ· Û˘Ó˘¿Ú¯Ô˘Û· ·ÈÙ›· Û οÔÈ· ÂÚÈÛÙ·ÙÈο.
ŒÓ·˜ ÙÂÏÂ˘Ù·›Ô˜ Ì˯·ÓÈÛÌfi˜ ¤¯ÂÈ ÂÚÈÁÚ·Ê› ÛÂ
·ÛıÂÓ›˜ Ì ˘·Ú·¯ÓÔÂȉ‹ ·ÈÌÔÚÚ·Á›· fiÔ˘ ¤¯ÂÈ
·Ú·ÙËÚËı› ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ÎÔÚ˘Ê‹˜ Ù˘ ηډȿ˜ ·ÚfiÌÔÈ· Ì ·˘Ù‹ ÙˆÓ ·ÛıÂÓÒÓ Ì TTC. ∆Ô ÂӉȷʤÚÔÓ ÛËÌÂ›Ô Â›Ó·È ˆ˜ ¤¯ÂÈ Û˘Û¯ÂÙÈÛı› Ì ڋÍË
·Ó¢ڢÛÌ¿ÙˆÓ Ô˘ ÂÓÙÔ›˙ÔÓÙ·È ÛÙÔ ‹ÌÈÛ˘ ÙÔ˘ ÚfiÛıÈÔ˘ ÙÌ‹Ì·ÙÔ˜ ÙÔ˘ ·ÎÏÔ˘ ÙÔ˘ Willis. ∞˘Ù¿ Ù· ·Ó¢ڇÛÌ·Ù· ÂÓÙÔ›˙ÔÓÙ·È ¿Óˆ ·fi ÙËÓ ·Ì˘Á‰·Ï‹ ηÈ
ÙÔ ÊÏÔÈfi Ù˘ ‰ÂÍÈ¿˜ ÓËÛȉȷ΋˜ ‰ÂÍ·ÌÂÓ‹˜, Ô˘ ÂϤÁ¯Ô˘Ó ÙË Û˘Ì·ıËÙÈ΋ ‰Ú·ÛÙËÚÈfiÙËÙ· Ù˘ ηډȿ˜.30
∞Ó Î·È ·˘Ù‹ Ë ÙÂÏÂ˘Ù·›· ˘fiıÂÛË ÚÔÛʤÚÂÈ ÙfiÛÔ
·Ó·ÙÔÌÈ΋ fiÛÔ Î·È ÏÂÈÙÔ˘ÚÁÈ΋ ÂÍ‹ÁËÛË Ù˘ Ì˘Ôηډȷ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ·fi stress, ‰ÂÓ ˘¿Ú¯Ô˘Ó
ÚÔ˜ ÙÔ ·ÚfiÓ ÎÏÈÓÈο ‹ ÂÈÚ·Ì·ÙÈο ‰Â‰Ô̤ӷ ÁÈ·
Ó· ÙËÓ ÂȂ‚·ÈÒÛÔ˘Ó.
KÏÈÓÈο ÷ڷÎÙËÚÈÛÙÈο
∏ ÎÏÈÓÈο ÂÈÎfiÓ· ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Â›Ó·È Û˘¯Ó¿ ‰˘Û‰È¿ÎÚÈÙË ·fi ·˘Ù‹ ÂÓfi˜ ÔͤԘ ÛÙÂÊ·ÓÈ·›Ô˘ Û˘Ó‰ÚfiÌÔ˘. ∆Ô ÛÙËı·Á¯ÈÎfi ¿ÏÁÔ˜ ˘¿Ú¯ÂÈ Û¯Â‰fiÓ ¿ÓÙ·,
ÛÙÔ 100% ÙˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ÛÙȘ ÂÚÈÛÛfiÙÂÚ˜ ÛÂÈÚ¤˜. ∂Ó›ÔÙÂ Û˘Óԉ‡ÂÙ·È ·fi ‰‡ÛÓÔÈ·, ·›ÛıËÌ·
·ÏÌÒÓ, ÂÊ›‰ÚˆÛË, Ó·˘Ù›· ‹ Û˘ÁÎÔ‹. §ÈÁfiÙÂÚÔ Û˘¯Ó¿ ÂÌÊ·Ó›˙ÂÙ·È ·ÈÌÔ‰˘Ó·ÌÈ΋ ·ÛÙ¿ıÂÈ· Ì ˘fiÙ·ÛË ‹ ·ÎfiÌË Î·È Î·Ú‰ÈÔÁÂÓ‹ ηٷÏËÍ›·, ÔfiÙÂ
··ÈÙÂ›Ù·È Ì˯·ÓÈ΋ ˘ÔÛÙ‹ÚÈÍË Ù˘ ΢ÎÏÔÊÔÚ›·˜
.
.
Î·È Ù˘ ·Ó·ÓÔ‹˜.24 ∆· ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈο Â˘Ú‹Ì·Ù· Û˘Ó‹ıˆ˜ ÌÈÌÔ‡ÓÙ·È ·˘Ù¿ ÙÔ˘ ÔͤԘ ÂÌÊÚ¿ÁÌ·ÙÔ˜ Ì ‹ ¯ˆÚ›˜ ·Ó¿Û·ÛË ÙÔ˘ ST (∂ÈÎfiÓ· 2). √È
Sharkey Î·È Û˘Ó31 ÌÂϤÙËÛ·Ó ÂÈÛٷ̤ӈ˜ Ù· ∏∫°
59 ·ÛıÂÓÒÓ Ì TTC. ∫·Ù¿ ÙËÓ ÚÔÛ¤ÏÂ˘Û‹ ÙÔ˘˜ ÙÔ
56% ÙˆÓ ·ÛıÂÓÒÓ ÂÌÊ¿ÓÈÛ·Ó ·Ó¿Û·ÛË ÙÔ˘ ST, ÙÔ
17% ÂÌÊ¿ÓÈÛ ·Ó·ÛÙÚÔÊ‹ ÙˆÓ T Î·È ÙÔ 10% ·̷ٷ
Q ‹ Ùˆ¯‹ ÚfiÔ‰Ô ÙˆÓ R. ∞ÍÈÔÛËÌ›ˆÙÔ Â›Ó·È ÙÔ ÁÂÁÔÓfi˜ ˆ˜ ÙÔ ˘fiÏÔÈÔ 17% ÙˆÓ ·ÛıÂÓÒÓ Â›¯Â ›ÙÂ
ÌË ÂȉÈΤ˜ ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈΤ˜ ·ÏÏ·Á¤˜ ›Ù η̛· ·ÏÏ·Á‹. ∫·Ù¿ ÙË ‰È¿ÚÎÂÈ· Ù˘ Ê¿Û˘ ·Ó¿ÚÚˆÛ˘ ÙÔ ÈÔ Û˘¯Ó¿ ·Ú·ÙËÚÔ‡ÌÂÓÔ ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈÎfi ¯·Ú·ÎÙËÚÈÛÙÈÎfi ‹Ù·Ó Ë ·Ó·ÛÙÚÔÊ‹ ‹ Ë ÂÚ·ÈÙ¤Úˆ ·ÚÓËÙÈÎÔÔ›ËÛË ÙˆÓ Î˘Ì¿ÙˆÓ ∆ (΢ڛˆ˜
ÛÙȘ ··ÁˆÁ¤˜ V2 ¤ˆ˜ V6). ™ÙËÓ ›‰È· ÌÂϤÙË, ÙÔ Û˘ÓÔÏÈÎfi ¿ıÚÔÈÛÌ· Ù˘ ·Ó¿Û·Û˘ ÙÔ˘ ST ‹Ù·Ó ÌÈÎÚfiÙÂÚÔ Û ۯ¤ÛË Ì ÂΛÓÔ ÙˆÓ ·ÛıÂÓÒÓ Ì ·fiÊÚ·ÍË
ÙÔ˘ LAD. øÛÙfiÛÔ, Ë ÛËÌ·ÓÙÈ΋ ·ÏÏËÏÔÂÈÎ¿Ï˘„Ë
ÌÂٷ͇ ÙˆÓ ÚÔ·Ó·ÊÂÚıÂÈÛÒÓ ÙÈÌÒÓ ·ÔÎÏ›ÂÈ ÙË
¯Ú‹ÛË ÙˆÓ ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈÎÒÓ ·˘ÙÒÓ ·ÏÏ·ÁÒÓ
ˆ˜ ‰È·ÁÓˆÛÙÈÎfi ÂÚÁ·Ï›Ô. ∏ ·Ú¿Ù·ÛË ÙÔ˘ QTc ηÈ
Ë Â·ÓÂÌÊ¿ÓÈÛË ÙˆÓ Î˘Ì¿ÙˆÓ R ‹Ù·Ó Ù· ÈÔ ÎÔÈÓ¿
¯·Ú·ÎÙËÚÈÛÙÈο ηٿ ÙËÓ ÂͤÏÈÍË Ù˘ ÓfiÛÔ˘. ÕÏÏÔÈ
Û˘ÁÁÚ·Ê›˜ ¤¯Ô˘Ó ÂÚÈÁÚ¿„ÂÈ ˆ˜ ÔÈ ¿Û¯ÔÓÙ˜
·fi TTC ÂÌÊ·Ó›˙Ô˘Ó ‚·ı‡ÙÂÚ· ·ÚÓËÙÈο ·̷ٷ ∆
‹ ÈÔ ·Ú·ÙÂٷ̤ÓÔ QTc ‰È¿ÛÙËÌ· Û˘ÁÎÚÈÙÈο ÌÂ
ÙÔ˘˜ ¿Û¯ÔÓÙ˜ ·fi ÛÙÂÊ·ÓÈ·›· ÓfiÛÔ.32 ∏ ·Ô˘Û›·
ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈÎÒÓ ·ÏÏ·ÁÒÓ ‰›ÎËÓ Î·ÙfiÙÚÔ˘
ÛÙȘ ηÙÒÙÂÚ˜ ··ÁˆÁ¤˜ Î·È Ë ÙÈÌ‹ ÙÔ˘ ÎÏ¿ÛÌ·ÙÔ˜
Ù˘ ·Ó¿Û·Û˘ ÙÔ˘ ST ÛÙȘ ··ÁˆÁ¤˜ V4 – V6 ÚÔ˜
V1 – V3 ≥ 1, ¤¯Ô˘Ó Â›Û˘ ıˆÚËı› ÂȉÈο ¯·Ú·ÎÙËÚÈÛÙÈο ÁÈ· ÙË ‰È¿ÁÓˆÛË TTC33. øÛÙfiÛÔ, ·ÎfiÌË
Î·È ·˘Ù¿ Ù· ¯·Ú·ÎÙËÚÈÛÙÈο Â›Ó·È Ôχ ‰˘Û‰È¿ÎÚÈÙ·
ÁÈ· Ó· ‚ÔËı‹ÛÔ˘Ó ÛÙËÓ Î·ıËÌÂÚÈÓ‹ ÎÏÈÓÈ΋ Ú¿ÍË
A
ÛÙË ‰È·ÊÔÚÈ΋ ‰È¿ÁÓˆÛË ÙÔ˘ TTC ·fi ¤Ó· Ô͇ ÛÙÂÊ·ÓÈ·›Ô ÂÂÈÛfi‰ÈÔ. √È ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈΤ˜ ·ÏÏ·Á¤˜ Ô˘ ÂÌÊ·Ó›˙ÔÓÙ·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì TTC ÌÂ
ÙËÓ ¿ÚÔ‰Ô ÙÔ˘ ¯ÚfiÓÔ˘ ÌÔÈ¿˙Ô˘Ó ·ÚfiÌÔȘ Ì ·˘Ù¤˜ Ô˘ ·Ú·ÙËÚÔ‡ÓÙ·È ÛÙÔ˘˜ ·ÛıÂÓ›˜ Ì Ô͇ ¤ÌÊÚ·ÁÌ· ÙÔ˘ Ì˘Ôηډ›Ô˘ Ì ·Ó¿Û·ÛË ÙÔ˘ ST Ô˘
˘Ô‚¿ÏÏÔÓÙ·È Û ÚÒÈÌË Â·Ó·ÈÌ¿ÙˆÛË Ì ÙËÓ ·Ó·ÛÙÚÔÊ‹ ÙˆÓ Î˘Ì¿ÙˆÓ ∆ Ó· ‰È·ÙËÚÂ›Ù·È ÁÈ· ¯ÚÔÓÈÎfi
‰È¿ÛÙËÌ· ÙÔ˘Ï¿¯ÈÛÙÔÓ 2 – 3 ‚‰ÔÌ¿‰ˆÓ.32
™˘¯Ó¿, ·Ú·ÙËÚÂ›Ù·È ÌÈÎÚ‹ ·‡ÍËÛË Î·Ú‰È·ÎÒÓ
ÂÓ˙‡ÌˆÓ, ÂÓ‰ÂÈÎÙÈ΋ ̤ÙÚÈ·˜ ¤ÎÙ·Û˘ Ì˘Ôηډȷ΋˜
‚Ï¿‚˘. ∞fi ÙËÓ ¿ÏÏË ÌÂÚÈ¿, ÌÂϤÙ˜ ηډȷ΋˜
·ÂÈÎfiÓÈÛ˘ ·ÔηχÙÔ˘Ó ÂÎÙÂٷ̤ÓË ·ÎÈÓËÛ›· ‹
˘ÔÎÈÓËÛ›· Ù˘ ÎÔÚ˘Ê‹˜ ‹ ÙÔ˘ ̤ÛÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡
‰È·ÊÚ¿ÁÌ·ÙÔ˜, Â˘Ú‹Ì·Ù· ÌË Û˘Ì‚·Ù¿ Ì ÙËÓ ÌÈÎÚ‹
·‡ÍËÛË ÙˆÓ Î·Ú‰È·ÎÒÓ ÂÓ˙‡ÌˆÓ. ∞˘Ù¤˜ ÔÈ ‰È·Ù·Ú·¯¤˜ ÎÈÓËÙÈÎfiÙËÙ·˜ ÙÔ˘ Ì˘Ôηډ›Ô˘ ÂÎÙ›ÓÔÓÙ·È ¤Ú·Ó Ù˘ ¤ÎÙ·Û˘ ηٷÓÔÌ‹˜ ÌÈ·˜ ÛÙÂÊ·ÓÈ·›·˜ ·ÚÙËÚ›·˜ ˘Ô‰ËÏÒÓÔÓÙ·˜ ¤ÙÛÈ ˆ˜ Ô Èı·Ófi˜ Ì˯·ÓÈÛÌfi˜
Ù˘ ÔÍ›·˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Â›Ó·È Ë ·ÔÏËÍ›· (stunning) ÙÔ˘ Ì˘Ôηډ›Ô˘ ·Ú¿ Ë
Ó¤ÎÚˆÛË ·˘ÙÔ‡. ¶Ú¤ÂÈ Ó· ÛËÌÂȈı› ˆ˜ ¤Ó· ÌÈÎÚfi ÔÛÔÛÙfi ·ÛıÂÓÒÓ ‰ÂÓ ¤¯Ô˘Ó ·˘ÍË̤ӷ Ì˘Ôηډȷο ¤Ó˙˘Ì·, ÁÂÁÔÓfi˜ Ô˘ ÛËÌ·›ÓÂÈ ˆ˜ Ë ·Ô˘Û›·
·˘ÍËÌ¤ÓˆÓ Ì˘ÔηډȷÎÒÓ ÂÓ˙‡ÌˆÓ ‰ÂÓ ·ÔÎÏ›ÂÈ
ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘.
∏ Ù˘È΋ ÂÈÎfiÓ· “Tako – tsubo” Ù˘ ·ÚÈÛÙÂÚ‹˜
ÎÔÈÏ›·˜ ÌÔÚ› Ó· ·ÂÈÎÔÓÈÛı› Ì ˘ÂÚ˯ÔηډÈÔÁÚ¿ÊËÌ·, ÎÔÈÏÈÔÁÚ·Ê›· Ì ÛÎÈ·ÁÚ·ÊÈÎfi (∂ÈÎfiÓ· 3)
‹ ·ÂÈÎfiÓÈÛË Ì·ÁÓËÙÈÎÔ‡ Û˘ÓÙÔÓÈÛÌÔ‡ (MRI) (∂ÈÎfiÓ· 4). ∏ ÙÂÏÂ˘Ù·›· ÂͤٷÛË (MRI) Ì ¯Ú‹ÛË Á·‰ÔÏÈÓ›Ô˘, fiÙ·Ó Â›Ó·È ‰È·ı¤ÛÈÌË, ÌÔÚ› Ó· Â›Ó·È Ôχ
¯Ú‹ÛÈÌË Î·ıÒ˜ ·Ó·‰ÂÈÎÓ‡ÂÈ ÙËÓ ·Ô˘Û›· Ì˘Ôηډȷ΋˜ Ó¤ÎÚˆÛ˘ Ì ÂÈÎfiÓ˜ ηı˘ÛÙÂÚË̤Ó˘ Ï‹„˘
B
∂ÈÎfiÓ· 2. ∞Ó¿Û·ÛË ÙÔ˘ ST ÛÙȘ ··ÁˆÁ¤˜ V2 – V6 (‚¤ÏË) ηٿ ÙËÓ ÚÔۤϢÛË (A) ·ÎÔÏÔ˘ıÔ‡ÌÂÓ· ·fi ·Ó·ÛÙÚÔÊ‹ ÙˆÓ Î˘Ì¿ÙˆÓ T
ÛÙȘ ›‰È˜ ··ÁˆÁ¤˜ (‚¤ÏË) 2 Ë̤Ú˜ ·ÚÁfiÙÂÚ· (B) Û ·ÛıÂÓ‹ Ì TTC (‰È΋ Ì·˜ ÂÚ›ÙˆÛË).
A
B
∂ÈÎfiÓ· 3. ∫ÔÈÏÈÔÁÚ·Ê›· ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Ô˘ ‰Â›¯ÓÂÈ ‰˘ÛÎÈÓËÛ›· Ù˘ ÎÔÚ˘Ê‹˜ (ballooning) ηٿ ÙË Û˘ÛÙÔÏ‹
(A) Î·È Ê˘ÛÈÔÏÔÁÈ΋ Û˘ÛÙÔÏÈ΋ ÏÂÈÙÔ˘ÚÁ›· ÌÂÙ¿ ÙËÓ ·ÔηٿÛÙ·ÛË (B) Û ·ÛıÂÓ‹ Ì TTC (Mohamed HA.
Libyan J Med 2007; 2: 51-55, ·Ó·Ù‡ˆÛË Î·ÙfiÈÓ ¿‰ÂÈ·˜).
A
B
∂ÈÎfiÓ· 4. ∞ÂÈÎfiÓÈÛË Ì ̷ÁÓËÙÈÎfi Û˘ÓÙÔÓÈÛÌfi (MRI) Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ÛÙËÓ ÙÂÏԉȷÛÙÔÏ‹ (A) Î·È ÛÙËÓ ÙÂÏÔÛ˘ÛÙÔÏ‹ (B) Û ·ÛıÂÓ‹ Ì TTC (‰È΋ Ì·˜ ÂÚ›ÙˆÛË).
.
Ì ÂÓ›Û¯˘ÛË Û‹Ì·ÙÔ˜ (late enhancement images).
¶ÔÏϤ˜ ÚfiÛÊ·Ù˜ ‰ËÌÔÛȇÛÂȘ ÌÂÌÔÓˆÌ¤ÓˆÓ ÂÚÈÛÙ·ÙÈÎÒÓ ‹ ÌÈÎÚÒÓ ÛÂÈÚÒÓ ÙÔÓ›˙Ô˘Ó ÙÔ ÛËÌ·ÓÙÈÎfi
ÚfiÏÔ Ù˘ MRI ηډȿ˜ ÛÙË ‰È¿ÁÓˆÛË ·ÛıÂÓÒÓ ÌÂ
ÛÙËı¿Á¯Ë Î·È Ê˘ÛÈÔÏÔÁÈο ÛÙÂÊ·ÓÈ·›· ·ÁÁ›·.33-35
∂ÈÚfiÛıÂÙ·, ‰Â‰Ô̤Ó˘ Ù˘ ‰˘ÛÎÔÏ›·˜ ·ÍÈÔÏfiÁËÛ˘ Ù˘ ÌÔÚÊÔÏÔÁ›·˜ Î·È Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜ Ù˘
‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ ˘ÂÚ˯ÔηډÈÔÁÚ·ÊÈÎÒ˜, Ë MRI
ÌÔÈ¿˙ÂÈ Ó· ·ÔÙÂÏ› ÙÔ Î·Ï‡ÙÂÚÔ ÂÚÁ·ÏÂ›Ô ÁÈ· ÙË
‰È¿ÁÓˆÛË Ù˘ Ù˘¯fiÓ Û˘ÌÌÂÙÔ¯‹˜ Î·È Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ ÛÙÔ TCC. ∂›Ó·È ·ÍÈÔÛËÌ›ˆÙÔ ÙÔ ÁÂÁÔÓfi˜ ˆ˜ Ë
‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ‰ÂÍÈ¿˜ ÎÔÈÏ›·˜ ÂÓÒ ·Ú¯Èο ·Ó·ÊÂÚfiÙ·Ó ÌfiÓÔ Û ÌÂÌÔӈ̤ӷ ÂÚÈÛÙ·ÙÈο, Û ÈÔ
ÚfiÛÊ·Ù˜ ‰ËÌÔÛȇÛÂȘ ·ÔÙÂÏ› ÈÔ Û˘¯Ófi ‡ÚËÌ· (26 – 30% ÙˆÓ ·ÛıÂÓÒÓ).37,38 ∆¤ÏÔ˜, ÌÈ· ÈÔ Û¿ÓÈ· ηٿÛÙ·ÛË ·ÔÙÂÏ› Ë ÂÌÊ¿ÓÈÛË ˘ÂÚÎÈÓËÛ›·˜
Ù˘ ÎÔÚ˘Ê‹˜ ÛÂ Û˘Ó‰˘·ÛÌfi Ì ˘ÔÎÈÓËÛ›· ÙˆÓ ‚·ÛÈÎÒÓ ÙÌËÌ¿ÙˆÓ (ÙÔ ·ÔηÏÔ‡ÌÂÓÔ Î·È ·Ó¿ÛÙÚÔÊÔ
Tako – tsubo syndrome) Î·È ¤¯ÂÈ ÂÚÈÁÚ·Ê› ÚfiÛÊ·Ù· Û ·ÛıÂÓ›˜ ¿Û¯ÔÓÙ˜ ·fi ÛÔ‚·Ú¤˜ ÂÓ‰ÔÎÚ¿ÓȘ ÓfiÛÔ˘˜ ‹ ÎÚ›ÛÂȘ Ê·ÈÔ¯ÚˆÌÔ΢ÙÒÌ·ÙÔ˜.39,40
ŒÓ·˜ ·ÛıÂÓ‹˜ Ì TTC Û˘Ó‹ıˆ˜ ıˆÚÂ›Ù·È ·Ú¯Èο ¿Û¯ˆÓ ·fi Ô͇ ÛÙÂÊ·ÓÈ·›Ô Û‡Ó‰ÚÔÌÔ Î·È
·Ú·¤ÌÂÙ·È ÂÂÈÁfiÓÙˆ˜ ÛÙÔ ·ÈÌÔ‰˘Ó·ÌÈÎfi ÂÚÁ·ÛÙ‹ÚÈÔ ÁÈ· ÛÙÂÊ·ÓÈÔÁÚ·Ê›·. ∆Ô Ù˘ÈÎfi ‡ÚËÌ· Â›Ó·È Ë ·Ô˘Û›· ÛËÌ·ÓÙÈ΋˜ ÛÙ¤ÓˆÛ˘ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ Ô˘ Ó· ‰ÈηÈÔÏÔÁ› ÙÔ ÂÂÈÛfi‰ÈÔ.
øÛÙfiÛÔ, ÔÈ Ibanez et al41 Ì ÙË ¯Ú‹ÛË ÂÓ‰ÔÛÙÂÊ·ÓÈ·›Ô˘ ˘ÂÚ‹¯Ô˘ ÂÚȤÁÚ·„·Ó ÙËÓ ·ÚÔ˘Û›· ÚËÁÌ¤ÓˆÓ ·ıËÚÔÛÎÏËÚ˘ÓÙÈÎÒÓ Ï·ÎÒÓ Û οÔÈÔ˘˜
·ÛıÂÓ›˜. ∆Ô Â¿Ó ·˘Ùfi ÙÔ Â‡ÚËÌ· ¤¯ÂÈ Î¿ÔÈ· ·ıÔÊ˘ÛÈÔÏÔÁÈ΋ Û˘Û¯¤ÙÈÛË Ì ÙÔ Û‡Ó‰ÚÔÌÔ ·Ú·Ì¤ÓÂÈ ·ÎfiÌË ¿ÁÓˆÛÙÔ.
¶›Ó·Î·˜ 1. ∫ÚÈÙ‹ÚÈ· ÁÈ· ÙË ‰È¿ÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ∆ako
Tsubo Ô˘ ¤¯Ô˘Ó ÚÔÙ·ı› ·fi ÙËÓ Mayo Clinic.42
1. ¶·ÚÔ‰È΋ ·ÎÈÓËÛ›· ‹ ‰˘ÛÎÈÓËÛ›· Ù˘ ÎÔÚ˘Ê‹˜ Ù˘ ·ÚÈÛÙÂÚ‹˜
ÎÔÈÏ›·˜ Î·È ÙˆÓ Ì¤ÛˆÓ ÙÌËÌ¿ÙˆÓ Ì ÙÌËÌ·ÙÈΤ˜ ‰È·Ù·Ú·¯¤˜ Ù˘
ÎÈÓËÙÈÎfiÙËÙ·˜ Ô˘ ÂÎÙ›ÓÔÓÙ·È ¤Ú·Ó Ù˘ ηٷÓÔÌ‹˜ ÂÓfi˜
ÂÈηډȷÎÔ‡ ÛÙÂÊ·ÓÈ·›Ô˘ ·ÁÁ›Ԣ.
2. ∞Ô˘Û›· ·fiÊڷ͢ ÛÙÂÊ·ÓÈ·›Ô˘ ·ÁÁ›Ԣ ‹ ·ÁÁÂÈÔÁÚ·ÊÈ΋˜
¤Ó‰ÂÈ͢ ڋ͢ ·ıËڈ̷ÙÈ΋˜ Ͽη˜.
3. ¡ÂÔÂÌÊ·ÓÈÛı›Û˜ ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈΤ˜ ·ÓˆÌ·Ï›Â˜ (·Ó¿Û·ÛË ÙÔ˘ ST ‹ ·Ó·ÛÙÚÔÊ‹ ÙˆÓ Î˘Ì¿ÙˆÓ T)
4. ∞Ô˘Û›· ÂÓfi˜ ·fi Ù· ·Ú·Î¿Ùˆ:
¶ÚfiÛÊ·ÙÔ ÙÚ·‡Ì· ÎÂÊ·Ï‹˜
∂Ó‰ÔÎÚ¿ÓÈ· ·ÈÌÔÚÚ·Á›·
º·ÈÔ¯ÚˆÌÔ·Ùو̷
∞fiÊÚ·ÍË ÂÈηډȷÎÒÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ
ª˘Ôηډ›Ùȉ·
ÀÂÚÙÚÔÊÈ΋ Ì˘ÔηډÈÔ¿ıÂÈ·
.
ªÂ ‚¿ÛË ÙËÓ ÂÌÂÈÚ›· Ù˘ Î·È ÙȘ ˘¿Ú¯Ô˘Û˜
ÁÓÒÛÂȘ, ÌÈ· ÔÌ¿‰· ·fi ÙËÓ Mayo Clinic ¤¯ÂÈ ÚÔÙ›ÓÂÈ Î¿ÔÈ· ÎÚÈÙ‹ÚÈ· ÁÈ· ÙËÓ ÎÏÈÓÈ΋ ‰È¿ÁÓˆÛË ÙÔ˘
TTC (¶›Ó·Î·˜ 1) 42 ·Ó·ÁÓˆÚ›˙ÔÓÙ·˜ Ê˘ÛÈο ˆ˜
˘¿Ú¯Ô˘Ó Î·È ÔÈ ÂÍ·ÈÚ¤ÛÂȘ.
∞ÓÙÈÌÂÙÒÈÛË Î·È ¶ÚfiÁÓˆÛË
∏ ȉ·ÓÈ΋ ıÂÚ·›· ÁÈ· ÙÔ TTC ·Ú·Ì¤ÓÂÈ ¿ÁÓˆÛÙË. ∏ ·Ú¯È΋ ·ÓÙÈÌÂÙÒÈÛË Ú¤ÂÈ Ó· Û˘Ó›ÛٷٷÈ
ÛÙËÓ ·ÓÙÈÌÂÙÒÈÛË Ù˘ Ì˘Ôηډȷ΋˜ ÈÛ¯·ÈÌ›·˜.43 √
·ÛıÂÓ‹˜ ı· Ú¤ÂÈ Ó· ˘Ô‚¿ÏÏÂÙ·È ¿ÌÂÛ· Û ÛÙÂÊ·ÓÈÔÁÚ·Ê›· ηıÒ˜ Ë ‰È¿ÁÓˆÛË ÙÔ˘ TTC fiˆ˜ ›‰·Ì ··ÈÙ› ÙÔÓ ·ÔÎÏÂÈÛÌfi Ù˘ ‡·Ú͢ ÛËÌ·ÓÙÈ΋˜ ÛÙ¤ÓˆÛ˘ ÙˆÓ ÛÙÂÊ·ÓÈ·›ˆÓ ·ÁÁ›ˆÓ. ∂ÈÚfiÛıÂÙ·, Ô Î¿ı ·ÛıÂÓ‹˜ Ô˘ ÂÌÊ·Ó›˙ÂÈ Ô͇ ÛÙËı·Á¯ÈÎfi ¿ÏÁÔ˜, ËÏÂÎÙÚÔηډÈÔÁÚ·ÊÈΤ˜ ‰È·Ù·Ú·¯¤˜ ηÈ
‰È·Ù·Ú·¯¤˜ ÎÈÓËÙÈÎfiÙËÙ·˜ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Â›Ó·È Ôχ ÈÔ Èı·Ófi Ó· ¿Û¯ÂÈ ·fi √∂ª, ÔfiÙ ٷ
ÔʤÏË ·fi ÙËÓ ÚˆÙÔÁÂÓ‹ ·ÁÁÂÈÔÏ·ÛÙÈ΋ Â›Ó·È Ôχ ÛËÌ·ÓÙÈο. °È· ÙÔÓ ›‰ÈÔ ÏfiÁÔ, ı· Ú¤ÂÈ ·Ì¤Ûˆ˜
Ó· ·Ú¯›˙ÂÈ ıÂÚ·›· Ì ¯ÔÚ‹ÁËÛË ·ÛÈÚ›Ó˘, ÎÏÔȉÔÁÚ¤Ï˘, ÓÈÙÚˆ‰ÒÓ, ÂÓ‰ÔÊϤ‚È·˜ Ë·Ú›Ó˘ Î·È ‚ –
·Ó·ÛÙÔϤˆÓ. ∂›Û˘, ÂӉ›ÎÓ˘Ù·È Ë Û˘Ó¯‹˜ ·ÈÌÔ‰˘Ó·ÌÈ΋ ·Ú·ÎÔÏÔ‡ıËÛË ÙÔ˘ ·ÛıÂÓÔ‡˜ ÁÈ· ÙËÓ Èı·Ó‹ ÂÌÊ¿ÓÈÛË Î·Ú‰È·Î‹˜ ·ÓÂ¿ÚÎÂÈ·˜, ηډÈÔÁÂÓÔ‡˜
ηٷÏËÍ›·˜ ‹ ηÎÔ‹ıˆÓ ·ÚÚ˘ıÌÈÒÓ. ∂ÊfiÛÔÓ ‚¤‚·È· ÙÂı› Ë ‰È¿ÁÓˆÛË ÙÔ˘ TTC, ÙfiÛÔ Ù· ·ÓÙÈ·ÈÌÔÂÙ·Ïȷο fiÛÔ Ù· ÓÈÙÚÒ‰Ë Ú¤ÂÈ Ó· ‰È·ÎÔÔ‡Ó.
∞fi ÙËÓ ¿ÏÏË, ÔÈ ‚ – ·Ó·ÛÙÔÏ›˜ Ú¤ÂÈ Ó· Û˘Ó¯›ÛÔ˘Ó Ó· ¯ÔÚËÁÔ‡ÓÙ·È, ÌÈ·˜ Î·È ÔÈ Î·Ù¯ÔϷ̛Ә
ÂÓÔ¯ÔÔÈÔ‡ÓÙ·È ÁÈ· ÙÔ ÎÏÈÓÈÎfi ·˘Ùfi Û‡Ó‰ÚÔÌÔ, ÂÓÒ
·Ú¿ÏÏËÏ· ··ÈÙÂ›Ù·È ¤Ó·ÚÍË ·Ó·ÛÙÔϤˆÓ ÙÔ˘ ÌÂÙ·ÙÚÂÙÈÎÔ‡ ÂÓ˙‡ÌÔ˘ ̤¯ÚȘ fiÙÔ˘ ‚ÂÏÙȈı› Ë Î·Ú‰È·Î‹ ÏÂÈÙÔ˘ÚÁ›·. ∆· ‰ÈÔ˘ÚËÙÈο ıˆÚÔ‡ÓÙ·È ··Ú·›ÙËÙ· ÂÊfiÛÔÓ ˘¿Ú¯Ô˘Ó Û˘ÌÙÒÌ·Ù· Û˘ÌÊÔÚËÙÈ΋˜ ηډȷ΋˜ ·ÓÂ¿ÚÎÂÈ·˜. ™ÙËÓ ÂÚ›ÙˆÛË ÛÔ‚·ÚÔ‡ ‚·ıÌÔ‡ Û˘ÛÙÔÏÈ΋˜ ‰˘ÛÏÂÈÙÔ˘ÚÁ›·˜ ··ÈÙ›ٷÈ
ıÂÚ·›· Ì ·ÓÙÈËÎÙÈο, ÒÛÙ ӷ ÂÏ·ÙÙˆı› Ô Î›Ó‰˘ÓÔ˜ ıÚÔÌ‚ÔÂÌ‚ÔÏÈÎÒÓ ÂÂÈÛÔ‰›ˆÓ.44 ∂› ÛÔ‚·Ú‹˜
˘fiÙ·Û˘ ı· ÌÔÚÔ‡Û·Ó Ó· ‰ÔÎÈÌ·ÛÙÔ‡Ó ÔÈ ‚ – ·Ó·ÛÙÔÏ›˜ Â¿Ó Ë ˘fiÙ·ÛË ÔÊ›ÏÂÙ·È Û ·fiÊÚ·ÍË ÙÔ˘
¯ÒÚÔ˘ ÂÍfi‰Ô˘ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ÏfiÁˆ ÌÂÙ·‚ÔÏ‹˜ Ù˘ ÁˆÌÂÙÚ›·˜ Ù˘ ηٿ ÙË Û˘ÛÙÔÏ‹. øÛÙfiÛÔ,
Â¿Ó ˘¿Ú¯ÂÈ ·ÓÂ¿ÚÎÂÈ· ·ÓÙÏ›·˜ ÂӉ›ÎÓ˘Ù·È Ë ¯ÔÚ‹ÁËÛË ÈÓÔÙÚfiˆÓ ‹ Ë ÂÊ·ÚÌÔÁ‹ ÂÓ‰Ô·ÔÚÙÈ΋˜
·ÓÙÏ›·˜. ∫¿ÔÈÔÈ Û˘ÁÁÚ·Ê›˜ Û˘ÓËÁÔÚÔ‡Ó ˘¤Ú Ù˘
¿ÌÂÛ˘ ÙÔÔı¤ÙËÛ˘ ÂÓ‰Ô·ÔÚÙÈ΋˜ ·ÓÙÏ›·˜ ηıÒ˜ Ë
¯Ú‹ÛË ÈÓÔÙÚfiˆÓ ÌÔÚ› Ó· ÂȉÂÈÓÒÛÂÈ ÙËÓ ‹‰Ë ·˘ÍË̤ÓË ÂÓ‰ÔÎÔÈÏÔÙÈ΋ ÎÏ›ÛË ›ÂÛ˘. ∂ÈÚfiÛıÂÙ·,
ÂÊfiÛÔÓ ÔÈ Î·Ù¯ÔϷ̛Ә Î·È Ë ÚÔηÏÔ‡ÌÂÓË ·fi
..
·˘Ù¤˜ ÙÔÍÈÎfiÙËÙ· ıˆÚÔ‡ÓÙ·È ˘‡ı˘Ó˜ ÁÈ· ÙËÓ ÂÌÊ¿ÓÈÛË TTC, Ë ‰Ô‚Ô˘Ù·Ì›ÓË Î·È Ë ÓÙÔ·Ì›ÓË ı·
ÌÔÚÔ‡Û·Ó ıˆÚËÙÈο Ó· ÂȉÂÈÓÒÛÔ˘Ó ÙË ‰˘ÛÏÂÈÙÔ˘ÚÁ›· Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜. ∞fi ÙËÓ ¿ÏÏË, Ë Ï‚ÔÛÈÌÂÓ‰¿ÓË Ô˘ Â›Ó·È Â˘·ÈÛıËÙÔÔÈËÙ‹˜ ·Û‚ÂÛÙ›Ô˘, ı· ÌÔÚÔ‡Û ӷ ·ÔÙÂÏ› ÌÈ· ‰Â‡ÙÂÚ˘ ÁÚ·ÌÌ‹˜
ıÂÚ·›·. 28 ™ÙËÓ ÂÚ›ÙˆÛË ÂÌÊ¿ÓÈÛ˘ ÛÔ‚·ÚÔ‡
‚·ıÌÔ‡ ηډÈÔÁÂÓÔ‡˜ ηٷÏËÍ›·˜ Ë ÚÔÛˆÚÈÓ‹
Ì˯·ÓÈ΋ ˘Ô‚Ô‹ıËÛË Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ÌÔÚ›
Ó· ηٷÛÙ› ·Ó·Áη›·. ∂‰Ò, ı· Ú¤ÂÈ Ó· ÙÔÓÈÛÙ›
ˆ˜ η̛· ·fi ÙȘ ·Ú·¿Óˆ ıÂÚ·¢ÙÈΤ˜ ÂÈÏÔÁ¤˜ ‰ÂÓ ¤¯ÂÈ ‰ÔÎÈÌ·ÛÙ› ÛÙËÓ ÎÏÈÓÈ΋ Ú¿ÍË, οÙÈ
Ô˘ ‰ÂÓ ÌÔÈ¿˙ÂÈ Èı·ÓfiÓ Ó· Û˘Ì‚Â› Î·È ÛÙÔ ¿ÌÂÛÔ
̤ÏÏÔÓ ‰Â‰Ô̤ÓÔ˘ ÙÔ˘ ¯·ÌËÏÔ‡ ÂÈÔÏ·ÛÌÔ‡ ÙÔ˘
Û˘Ó‰ÚfiÌÔ˘ Î·È Ù˘ ηÏÔ‹ıÔ˘˜ ÚfiÁÓˆÛ‹˜ ÙÔ˘.
∏ ‰È¿ÚÎÂÈ· Ù˘ ıÂÚ·›·˜ ‰ÂÓ ¤¯ÂÈ Â›Û˘ ·ÔÛ·ÊËÓÈÛÙ› ·ÏÏ¿ ÌÔÈ¿˙ÂÈ ÏÔÁÈÎfi Ó· ·Ú·Ù›ÓÂÙ·È
¤ˆ˜ fiÙÔ˘ Ê˘ÛÈÔÏÔÁÈÎÔÔÈËı› Ï‹Úˆ˜ Ë Î·Ú‰È·Î‹
ÏÂÈÙÔ˘ÚÁ›·.
∏ ÚfiÁÓˆÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ Û˘Ó‹ıˆ˜ Â›Ó·È Î·Ï‹ Ì Ï‹ÚË ·ÔηٿÛÙ·ÛË Ù˘ ÏÂÈÙÔ˘ÚÁÈÎfiÙËÙ·˜
Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ ÂÓÙfi˜ 2 – 4 ‚‰ÔÌ¿‰ˆÓ ·fi
ÙËÓ ¤Ó·ÚÍË ÙˆÓ Û˘ÌÙˆÌ¿ÙˆÓ ÛÙËÓ ÏÂÈÔÓfiÙËÙ· ÙˆÓ
ÂÚÈÙÒÛˆÓ. √È ÈÔ Û˘¯Ó¤˜ ÂÈÏÔΤ˜ Ô˘ ¤¯Ô˘Ó
ÂÚÈÁÚ·Ê›, ·Ó¿ÏÔÁ· Ì ÙÔ ÔÛÔÛÙfi ÂÌÊ¿ÓÈÛ˘, Â›Ó·È ÔÈ ·ÎfiÏÔ˘ı˜: ηډÈÔÁÂÓ‹˜ ηٷÏËÍ›· (6,5%),
Û˘ÌÊÔÚËÙÈ΋ ηډȷ΋ ·ÓÂ¿ÚÎÂÈ· (3,8%), ÎÔÈÏȷ΋ Ù·¯˘Î·Ú‰›· (1,6%) Î·È ı¿Ó·ÙÔ˜ (3,2%).16 ªÔÏ·Ù·‡Ù· ¤¯Ô˘Ó ÂÚÈÁÚ·Ê› Î·È ˘„ËÏfiÙÂÚ· ÔÛÔÛÙ¿
ıÓËÛÈÌfiÙËÙ·˜ ¿Óˆ ÙÔ˘ 21%.33 ÕÏϘ Û·ÓÈfiÙÂÚ˜
ÛÔ‚·Ú¤˜ ÂÈÏÔΤ˜ Â›Ó·È Ë Ú‹ÍË ÙÔ˘ ÌÂÛÔÎÔÈÏÈ·ÎÔ‡
‰È·ÊÚ¿ÁÌ·ÙÔ˜, Ë Ú‹ÍË ÙÔ˘ ÂÏ¢ı¤ÚÔ˘ ÙÔȯÒÌ·ÙÔ˜
Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜, Ô Û¯ËÌ·ÙÈÛÌfi˜ ıÚfiÌ‚Ô˘ ÛÙËÓ
ÎÔÚ˘Ê‹ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜ Î·È Ë ÂÌÊ¿ÓÈÛË ·ÁÁÂÈ·ÎÔ‡ ÂÁÎÂÊ·ÏÈÎÔ‡ ÂÂÈÛÔ‰›Ô˘.45,31 ¶·Ú¿ÁÔÓÙ˜
fiˆ˜ Ë ËÏÈΛ·, ÙÔ stress Î·È Ë ·Ó·ÛÙÚÔÊ‹ ÙˆÓ Î˘Ì¿ÙˆÓ ∆ ¤¯Ô˘Ó Û˘Û¯ÂÙÈÛı› Ì ·˘ÍË̤ÓÔ Î›Ó‰˘ÓÔ ÂÌÊ¿ÓÈÛ˘ ÂÈÏÔÎÒÓ.35 ∆¤ÏÔ˜, ·Ó Î·È Û¿ÓÈ·, ¤¯Ô˘Ó
·Ó·ÊÂÚı› ˘ÔÙÚÔ¤˜ ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘.36,37
™˘ÌÂÚ¿ÛÌ·Ù·
∆Ô Û‡Ó‰ÚÔÌÔ Tako – Tsubo ‹ Ì˘ÔηډÈÔ¿ıÂÈ· ·fi
stress ·ÔÙÂÏ› ÌÈ· ÌÔÚÊ‹ Ì˘ÔηډÈÔ¿ıÂÈ·˜ Ô˘
·Ó·ÁÓˆÚ›˙ÂÙ·È Û˘Ó¯Ҙ Û ·˘Í·ÓfiÌÂÓÔ ÔÛÔÛÙfi ˆ˜
ÚˆÙÔ·ı‹˜ ÌÔÚÊ‹ Ì˘ÔηډÈÔ¿ıÂÈ· Ô˘ Û˘Ì‚·›ÓÂÈ ÌÂÙ¿ ·fi οÔÈÔ ÛÙÚÂÛÛÔÁfiÓÔ ÂÂÈÛfi‰ÈÔ Î·È ¯·Ú·ÎÙËÚ›˙ÂÙ·È ·fi ·ÚÔ‰È΋ Û˘ÛÙÔÏÈ΋ ‰˘ÛÏÂÈÙÔ˘ÚÁ›· ΢ڛˆ˜ ÛÙËÓ ÎÔÚ˘Ê‹ Ù˘ ·ÚÈÛÙÂÚ‹˜ ÎÔÈÏ›·˜. ∏
ÎÏÈÓÈ΋ ÂÌÊ¿ÓÈÛË ÙÔ˘ Û˘Ó‰ÚfiÌÔ˘ ÚÔÛÔÌÔÈ¿˙ÂÈ ÌÂ
·˘Ù‹ ÙÔ˘ ÔͤԘ ÛÙÂÊ·ÓÈ·›Ô˘ Û˘Ó‰ÚfiÌÔ˘ Ì ÛÙËı·Á-.
¯ÈÎfi ¿ÏÁÔ˜, ÈÛ¯·ÈÌÈÎÔ‡ Ù‡Ô˘ ·ÏÏÔÈÒÛÂȘ ÙÔ˘ ST ηÈ
ÌÈÎÚ‹ ·‡ÍËÛË ÙˆÓ Ì˘ÔηډȷÎÒÓ ÂÓ˙‡ÌˆÓ. ∏ ÚfiÁÓˆÛË Â›Ó·È Î·Ï‹ Ì Ï‹ÚË ·ÔηٿÛÙ·ÛË Ù˘ ηډȷ΋˜ ÏÂÈÙÔ˘ÚÁ›·˜ ÂÓÙfi˜ 2 – 4 ‚‰ÔÌ¿‰ˆÓ ÛÙËÓ
ÏÂÈÔÓfiÙËÙ· ÙˆÓ ÂÚÈÙÒÛˆÓ. ∏ ‰ÈÂÓ¤ÚÁÂÈ· ÛÙÂÊ·ÓÈÔÁÚ·Ê›·˜ Â›Ó·È ··Ú·›ÙËÙË ÁÈ· Ó· ÙÂı› Ë ‰È¿ÁÓˆÛË ÂÓÒ Ë Ê·Ú̷΢ÙÈ΋ ıÂÚ·›· ‰Ú· ˘ÔÛÙËÚÈÎÙÈο. √ ·ıÔÁÂÓÂÙÈÎfi˜ Ì˯·ÓÈÛÌfi˜ ·Ú·Ì¤ÓÂÈ ÚÔ˜
ÙÔ ·ÚfiÓ ¿ÁÓˆÛÙÔ˜ ·Ó Î·È Ë ·˘ÍË̤ÓË Û˘ÁΤÓÙÚˆÛË
ηÙ¯ÔÏ·ÌÈÓÒÓ Ê·›ÓÂÙ·È Û·ÊÒ˜ Ó· ‰È·‰Ú·Ì·Ù›˙ÂÈ
ÚˆÙ‡ÔÓÙ· ÚfiÏÔ.
BÈ‚ÏÈÔÁÚ·Ê›·
1. Sato H, Tateishi H, Uchida T, et al. Takotsubo type cardiomyopathy due to multivessel spasm. In: Kodama K, Haze
K, Hon M, eds. Clinical aspect of myocardial injury:from ischaemia to heart failure. Tokyo: Kagakuhyouronsya. 1990;
56-64.
2. Dote K, Sato H, Tateishi H, Uchida T, Ishihara M. Myocardial stunning due to simultaneous multivessel coronary
spasms: a review of 5 cases. J Cardiol. 1991; 21: 203-214.
3. Maron BJ, Towbin JA, Thiene G, et al. Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council
on Clinical Cardiology, Heart Failure and Transplantation
Committee; Quality of Care and Outcomes Research and
Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and
Prevention. Circulation. 2006; 113: 1807-1816.
4. Kawai S, Suzuki H, Yamaguchi H, et al. Ampulla-shaped
ventricular dysfunction or ampulla cardiomyopathy? Respir
Circ. 2000; 48: 1237-1248.
5. Bybee KA, Prasad A, Barsness GW, et al. Clinical characteristics and thrombolysis in myocardial infarction frame counts
in women with transient left ventricular apical ballooning
syndrome. Am J Cardiol. 2004; 93: 343-346.
6. Azzarelli S, Galassi AR, Amico F, et al. Clinical features of
transient left ventricular apical ballooning. Am J Cardiol.
2006; 98:1273-1276.
7. Facciorusso A, Vigna C, Amico C et al, Prevalence of TakoTsubo Syndrome among patients with suspicion of acute
coronary syndrome referred to our centre. Int J Cardiol 2008
Apr 11. [Epub ahead of print].
8. Park JH, Kang SJ, Song JK, et al. Left ventricular apical ballooning due to severe physical stress in patients admitted to
the medical ICU. Chest. 2005; 128:296-302.
9. Hertting K, Krause K, Härle T, Boczor S, Reimers J, Kuck
KH. Transient left ventricular apical ballooning in a community hospital in Germany. Int J Cardiol. 2006; 112: 282288.
10. Stollberger C, Finsterer J, Schneider B. Tako-tsubo-like left
ventricular dysfunction: clinical presentation, instrumental
findings, additional cardiac and non-cardiac diseases and potential pathomechanisms. Minerva Cardioangiol. 2005;
53:139-145.
11. Tsuchihashi K, Ueshima K, Uchida T, et al. Transient left
ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial in-
.
.
12.
13.
14.
15.
16.
17.
18.
19.
20.
21.
22.
23.
24.
25.
26.
27.
28.
29.
farction. Angina Pectoris-Myocardial Infarction Investigations in Japan. J Am Coll Cardiol. 2001; 38: 11-18.
Sharkey SW, Lesser JR, Zenovich AG, Maron MS, Lindberg
J, Longe TF, et al. Acute and reversible cardiomyopathy
provoked by stress in women from the United States. Circulation 2005; 111: 472-479.
Desmet WJ, Adriaenssens BF, Dens JA. Apical ballooning
of the left ventricle: first series in white patients. Heart.
2003; 89:1027-1031.
Abdulla I, Kay S, Mussap C, et al. Apical sparing in takotsubo cardiomyopathy. Intern Med J. 2006; 36: 414-418.
Haghi D, Fluechter S, Suselbeck T, et al. Takotsubo cardiomyopathy (acute left ventricular apical ballooning syndrome) occurring in the intensive care unit. Intensive Care
Med. 2006; 32: 1069-1074.
Donohue D, Movahed MR. Clinical characteristics, demographics and prognosis of transient left ventricular apical
ballooning syndrome. Heart Fail Rev. 2005; 10: 311-316.
Ibáñez B, Navarro F, Farré J, et al. Tako-tsubo syndrome associated with a long course of the left anterior descending
coronary artery along the apical diaphragmatic surface of
the left ventricle. Rev Esp Cardiol. 2004; 57: 209-216.
Kurisu S, Sato H, Kawagoe T, et al. Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction. Am
Heart J. 2002; 143: 448-455.
Abe Y, Kondo M, Matsuoka R, Araki M, Dohyama K,
Tanio H. Assessment of clinical features in transient left
ventricular apical ballooning. J Am Coll Cardiol. 2003; 41:
737-742.
Giordan M, Rigatelli G, Cardaioli P, Di Marco F. Angiographic long term follow-up of primary apical ballooning of
the left ventricle. Int J Cardiovasc Imaging 2006; 22: 349-352.
Elesber A, Lerman A, Bybee KA, et al. Myocardial perfusion in apical ballooning syndrome: correlate of myocardial
injury. Am Heart J. 2006; 152: 469. e9-13.
Sadamatsu K, Tashiro H, Maehira N, Yamamoto K.
Coronary microvascular abnormality in the reversible systolic dysfunction observed after noncardiac disease. Jpn Circ
J 2000; 64: 789-792.
Yoshida T, Hibino T, Kako N, et al. A pathophysiologic
study of tako-tsubo cardiomyopathy with F-18 fluorodeoxyglucose positron emission tomography. Eur Heart J.
2007; 28: 2598-2604.
Wittstein IS, Thiemann DR, Lima JA, et al. Neurohumoral
features of myocardial stunning due to sudden emotional
stress. N Engl J Med. 2005; 352: 539-548.
Nef HM, Möllmann H, Kostin S, et al. Tako-Tsubo cardiomyopathy: intraindividual structural analysis in the acute
phase and after functional recovery. Eur Heart J. 2007; 28:
2456-2464.
Kume T, Kawamoto T, Okura H, et al. Local release of catecholamines from the hearts of patients with tako-tsubo-like
left ventricular dysfunction. Circ J 2008; 72: 106-108.
Mori H, Ishikawa S, Kojima S, et al. Increased responsiveness of the left ventricular apical myocardium to adrenergic
stimuli. Cardiovasc Res. 1993; 27: 192-198.
Lyon AR, Rees PS, Prasad S, Poole-Wilson PA, Harding SE.
Stress (Takotsubo) cardiomyopathy-a novel pathophysiological hypothesis to explain catecholamine-induced acute myocardial stunning. Nat Clin Pract Cardiovasc Med. 2008; 5:
22-29.
Merli E, Sutcliffe S, Gori M, Sutherland GG. Tako-Tsubo
30.
31.
32.
33.
34.
35.
36.
37.
38.
39.
40.
41.
42.
43.
44.
cardiomyoapthy: new insights into the possible underlying
pathophysiology. Eur J Echocardiogr. 2006; 7: 53-61.
Khush K, Kopelnik A, Tung P, et al. Age and aneurysm position predict patterns of left ventricular dysfunction after subarachnoid hemorrhage. J Am Soc Echocardiogr. 2005; 18:
168-174.
Sharkey SW, Lesser JR, Menon M, Parpart M, Maron MS,
Maron BJ. Spectrum and significance of electrocardiographic patterns, troponin levels, and thrombolysis in myocardial
infarction frame count in patients with stress (tako-tsubo)
cardiomyopathy and comparison to those in patients with ST
elevation anterior wall myocardial infarction. Am J Cardiol.
2008; 101: 1723-1728.
Kurisu S, Inoue I, Kawagoe T, et al. Time course of electrocardiographic changes in patients with tako-tsubo syndrome
comparison with acute myocardial infarction with minimal
enzymatic release. Circ J. 2004; 68: 77-81.
Ogura R, Hiasa Y, Takahashi T, et al. Specific findings of
the standard 12-lead ECG in patients with “Takotsubo” cardiomyopathy-comparison with the findings of acute anterior
myocardial infarction. Circ J. 2003; 67: 687-689.
Eitel I, Behrendt F, Schindler K, Gutberlet M, Schuler G,
Thiele H. Takotsubo cardiomyopathy or myocardial infarction? Answers from delayed enchancement magnetic resonance imaging. Int J Cardiol 2008, June 30 [Epub ahead of
print].
Mitchell JH, Hadden TB, Wilson JM, Achari A, Muthupillai
R, Flamm SD. Clinical features and usefulness of cardiac
magnetic resonance imaging in assessing myocardial viability
and prognosis in Takotsubo cardiomyopathy (transient left
ventricular apical ballooning syndrome). Am J Cardiol.
2007; 100: 296-301.
Assomull RG, Lyne JC, Keenan N, et al. The role of cardiovascular magnetic resonance in patients presenting with
chest pain, raised troponin, and unobstructed coronary arteries. Eur Heart J. 2007; 28: 1242-1249.
Elesber AA, Prasad A, Bybee KA, et al. Transient cardiac
apical ballooning syndrome: prevalence and clinical implications of right ventricular involvement. J Am Coll Cardiol.
2006; 47: 1082-1083.
Haghi D, Athanasiadis A, Papavassiliu T, et al. Right ventricular involvement in Takotsubo cardiomyoapthy. Eur
Heart J. 2006; 27: 2433-2439.
Ennezat PV, Pesenti-Rossi D, Aubert JM, et al. Transient
left ventricular basal dysfunction without coronary stenosis
in acute cerebral disorders: a novel heart syndrome (inverted Takotsubo). Echocardiography. 2005; 22: 599-602.
Sanchez-Recalde A, Costero O, Oliver JM, Iborra C, Ruiz E,
Sobrino JA. Images in cardiovascular medicine. Pheochromocytoma-related cardiomyopathy: inverted Takotsubo contractile pattern. Circulation. 2006; 211: e738-739.
Ibáñez B, Navarro F, Cordoba M, M-Alberca P, Farre J.
Tako-tsubo transient left ventricular apical ballooning: is intravascular ultrasound the key to resolve the enigma? Heart.
2005; 91: 102-104.
Prasad A. Apical ballooning syndrome: an important differential diagnosis of acute myocardial infarction. Circulation.
2007; 115: e56-59.
Buchholz S, Rudan G. Tako-tsubo syndrome on the rise: a
review of the current literature. Postgrad Med J. 2007; 83:
261-264.
Kurisu S, Inoue I, Kawagoe T, et al. Left ventricular apical
thrombus formation in a patient with suspected tako-tsubo-..
.
like left ventricular dysfunction. Circ J. 2003; 67: 556-558.
45. Bonello L, Com O, Ait-Moktar O, et al. Ventricular arrhythmias during Tako-tsubo syndrome. Int J Cardiol. 2008; 128:
e50-53.
46. Ohara Y, Hiasa Y, Hosokawa S, et al. Left ventricular free
wall rupture in transient left ventricular apical ballooning.
Circ J. 2005; 69: 621-623.
47. Movahed MR, Donohue D. Review: transient left ventricular apical ballooning, broken heart syndrome, ampulla car-
diomyopathy, atypical apical ballooning, or Tako-Tsubo cardiomyopathy. Cardiovasc Revasc Med. 2007; 8: 289-292.
48. CherianJ, Angelis D, Filiberti A, Saperia G. Recurrence of
stress induced (takotsubo) cardiomyoapthy. Cardiology.
2006; 108: 144-146.
49. Yoshida T, Hibino T, Fujimaki T, et al. The recurrence of
tako-tsubo cardiomyopathy complicated by cardiogenic
shock: A case report. Int J Cardiol 2008 June 16. [Epub
ahead of print].