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16JAMA. 2011;306(3):277-286 • タコツボ型心筋症は主に4つのパターンをとるCLINICAL CHARACTERISTICS OF STRESS CARDIOMYOPATHY ▫ Apical(82%), Midventricular(17%), Basal(1%), Biventricular pattern(34%).Figure 2. Cardiovascular Magnetic Resonance (CMR) Images of 4 Distinct Ballooning Patterns in Stress Cardiomyopathy and at 3-Month Follow-up A Apical ballooning Follow-up, 3 mo End diastole End systole End systole ∗ ∗ B Midventricular ballooning with sparing of apical and basal region Follow-up, 3 mo End diastole End systole End systole
17JAMA. 2011;306(3):277-286C Basal “inverted” ballooning Follow-up, 3 mo End diastole End systole End systoleD Biventricular ballooning with combined LV and RV dysfunction Follow-up, 3 mo End diastole End systole End systole ∗ ∗ ∗ ∗
Pericardial effusion, No. (%) 102 (43) 30 (37) 72 (46) 4 (2) 18 Thrombi, No. (%) 4 (2) 0 4 (3) 0JAMA. 2011;306(3):277-286 left ventricular. Abbreviations: CI, confidence interval; LV, a Comparisons between baseline and follow-up CMR results were performed only in patients with both CMR scans (at acute presentation and at follow-up). PϽ.001 for all comparisons. • また, MRCの評価では, 心筋の浮腫性変化を81%で認めた. careful history taking, only two-thirds of patients had a clearly identifiable pre- Figure 3. Cardiovascular MagneticCardiomyopathy Representative Patient With Stress Resonance Identification of Myocardial Edema in a ▫ その浮腫もフォローでほぼ全例消失している. ceding stressor, whereas in previous re- ports the percentage with preceding Basal myocardium Middle myocardium Apical myocardium emotional or physical triggers was as high as 89%.3 Thus, our large multi- center cohort demonstrates that the ab- sence of an identifiable stressful event does not rule out the diagnosis, and, hence, precipitating mechanisms may be more complex, such as involve- ment of vascular, endocrine, and cen- tral nervous systems. Such clinical heterogeneity could contribute to am- biguity in the recognition of SC and thereby affect potential management strategies. Consequently, enhanced awareness and recognition of a broad clinical profile of SC as demonstrated in the current study is mandatory for correct diagnosis and treatment among patients with suspected SC. T2-weighted images (short-axis view) demonstrating normal signal intensity (SI) of the basal myocardium but global edema of the mid and apical myocardium. Computer-aided SI analysis (bottom row) of the T2- weighted images with color-coded display of relative SI normalized to skeletal muscle (blue indicates an SI Ballooning Patterns ratio of myocardium to skeletal muscle of Ն1.9 or higher, indicating edema; green/yellow indicates a normal SI ratio of Ͻ1.9) confirm the presence of global mid and apical edema. Outlines of regions of interest are manu- We observed a diversity of contrac- ally drawn around the myocardium (red contour=subendocardial border; green contour=subepicardial bor- tion patterns during the acute phase of der) and within the skeletal muscle (contour not shown). SC, including apical, mid-ventricular, basal, and biventricular ballooning. Most commonly, the typical apical bal- ing. Since the initial description, the no apparent clinical differences be-