CORONARY ARTERY DISEASE AND TAKOTSUBO …
CORONARY ARTERY DISEASE AND TAKOTSUBO CARDIOMYOPATHY: CULPRIT OR INNOCENT BYSTANDER?
G.A. Delgado, A.G. Truesdell, R.M. Kirchner, R.W. Zuzek, E.V. Pomerantsev,
P.C. Gordon, R.A. Regnante
1Warren Alpert Medical School of Brown University, Providence, RI,
2Massachusetts General Hospital, Harvard Medical School, Boston, MA, USA
The precise etiology of Takotsubo cardiomyopathy (TC) remains controversial. The leading hypothesis involves catecholamine-induced microvascular spasm or dysfunction but conclusive data is lacking and prior studies of the macro and microvascular coronary circulation have shown conflictive results. Plaque rupture with transient thrombotic occlusion of a large, transapical left anterior descending coronary artery (LAD) causing an aborted myocardial infarction (MI) has been advanced as an alternative mechanism. To explore this hypothesis, we analyzed data from patients prospectively enrolled in the Rhode Island Takotsubo Cardiomyopathy Registry, fulfilling Mayo diagnostic criteria for TC, but found to have coronary artery disease (CAD) in the LAD. These patients were evaluated by contrast ventriculography, coronary angiography and intravascular ultrasound (IVUS) examination during their initial presentation. The course of the LAD on superimposed angiographic and left ventriculogram analysis failed to account for the typical left ventricular apical ballooning characteristic of TC. Quantitative coronary angiography revealed non-obstructive CAD with a median maximal LAD stenosis of 33 %
(IQR= 29-35.5). Medial minimal luminal area by IVUS was 6.3 mm2 (IQR=33-39). However, despite the presence of underlying CAD, IVUS did not reveal a potential culprit lesion, unstable plaque or thrombosis in any patient.
In conclusion, we propose that an atherosclerotic coronary lesion in the LAD causing an aborted MI is not the primary underlying etiology for TC and that non-obstructive CAD and TC may coexist without a direct causal association.
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