背景  研究人员已报告了由情感应激所引起的可逆性左心室功能障碍，但对其机制尚不了解。
　　BACKGROUND Reversible left ventricular dysfunction precipitated by emotional stress has been reported, but the mechanism remains unknown.
　　方法 我们对情感应激后有左心室功能障碍表现的19例病人进行评估。所有病人均接受冠状动脉造影和(定期)连续的超声心动图检查，5例接受心内膜心肌活检。检测了13例应激相关的心肌功能不全病人血浆儿茶酚胺水平，并将其与7例Killip分级Ⅲ级的心肌梗死病人进行比较。
　　METHODS We evaluated 19 patients who presented with left ventricular dysfunction after sudden emotional stress. All patients underwent coronary angiography and serial echocardiography; five underwent endomyocardial biopsy. Plasma catecholamine levels in 13 patients with stress-related myocardial dysfunction were compared with those in 7 patients with Killip class Ⅲ myocardial infarction.
　　结果 应激引起的心肌病病人的中位年龄为63岁，95%为女性。临床表现包括胸痛、肺水肿和心源性休克等。大多数病人有广泛性T波倒置和QT间期延长。17例病人有血清肌钙蛋白Ⅰ轻度升高，但19例病人中仅1例存在有临床意义的冠心病血管造影检查证据。所有病人入院时有严重的左心室功能障碍(射血分数的中位值为 0.20，四分位数间距为0.15～0.30)，但均迅速缓解(2～4周时的射血分数中位值为0.60，四分位数间距为0.55～0.65，P< 0.001)。心内膜活检有单个核细胞浸润与收缩带坏死的表现，应激导致的心肌病病人就诊时血浆儿茶酚胺水平显著高于Killip分级Ⅲ级的心肌梗死病人 [肾上腺素水平的中位值为1264 pg/ml(四分位间距范围为916～1374 pg/ml)对376 pg/ml (四分位间距范围为275～476 pg/ml)，去甲肾上腺素水平的中位值为2284 pg/ml(四分位间距范围为1709～2910 pg/ml)对1100 pg/ml(四分位间距范围为914～1320 pg/ml)，多巴胺水平的中位值为111 pg/ml(四分位间距范围为106～146 pg/ml)对61 pg/ml(四分位间距范围为46～77 pg/ml)，所有的比较P值均<0.005]
　　RESULTS The median age of patients with stress-induced cardiomyopathy was 63 years, and 95 percent were women. Clinical presentations included chest pain, pulmonary edema, and cardiogenic shock. Diffuse T-wave inversion and a prolonged QT interval occurred in most patients. Seventeen patients had mildly elevated serum troponin I levels, but only 1 of 19 had angiographic evidence of clinically significant coronary disease. Severe left ventricular dysfunction was present on admission (median ejection fraction, 0.20; interquartile range, 0.15 to 0.30) and rapidly resolved in all patients (ejection fraction at two to four weeks, 0.60; interquartile range, 0.55 to 0.65; P<0.001). Endomyocardial biopsy showed mononuclear infiltrates and contraction-band necrosis. Plasma catecholamine levels at presentation were markedly higher among patients with stress induced cardiomyopathy than among those with Killip class III myocardial infarction (median epinephrine level, 1264 pg per milliliter [interquartile range, 916 to 1374] vs. 376 pg per milliliter [interquartile range, 275 to 476]; norepinephrine level, 2284 pg per milliliter [interquartile range, 1709 to 2910] vs. 1100 pg per milliliter [interquartile range, 914 to 1320]; and dopamine level, 111 pg per milliliter [interquartile range, 106 to 146] vs. 61 pg per milliliter [interquartile range, 46 to 77]; P<0.005 for all comparisons).
　　结论 情感应激可导致无冠心病的病人发生严重的、可逆的左心室功能障碍。对于该综合征的发生原因，夸张的交感神经刺激可能十分重要。

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