Anteroapical Stunning and Left Ventricular Outflow Tract Obstruction

Villareal, Rollo P.; Achari, Arup; Wilansky, Susan; Wilson, James M.

doi:10.4065/76.1.79

Cited by 189 publications

(151 citation statements)

References 20 publications

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“…Recently, the theory of coronary vasospasm, originally proposed by Sato et al, 10 has been revived. 11,12 Other alternative hypotheses include transient obstruction of the left ventricular outflow tract 13 and disturbed microcirculatory flow. 14,15 Transient coronary occlusion by a rapidly dissolving thrombus is another proposed mechanism which is mainly based on data from a single IVUS study.…”

Section: Discussionmentioning

confidence: 99%

Takotsubo Cardiomyopathy Is Not Due to Plaque Rupture: An Intravascular Ultrasound Study

Haghi

Roehm

Hamm

et al. 2010

Clinical Cardiology

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BackgroundPlaque rupture with subsequent transient thrombotic coronary occlusion by a fast‐dissolving clot is one of the proposed pathogenic mechanisms in Takotsubo cardiomyopathy (TC).HypothesisThe aim of this study was to seek evidence for the hypothesis of transient coronary thrombosis as the underlying mechanism of TC by means of intravascular ultrasound (IVUS).MethodsIn our database of 63 consecutive patients with TC we identified 10 patients (16%) who had undergone IVUS during their initial left heart catheterisation.ResultsA median length of 67 mm of the left anterior descending artery was analyzed (interquartile range [IQR]: 63.3–70.1 mm). Median lumen diameter, median vessel diameter, median plaque and media volume were 2.9 mm (IQR: 2.7–3.1 mm), 4.2 mm (IQR: 3.8–4.4 mm), and 90.9 mm3 (IQR: 70.4–101.4 mm3), respectively. Plaque rupture, positive remodeling, and presumed intracoronary thrombus were absent in all patients.ConclusionIn conclusion, plaque rupture does not account for the regional wall motion abnormalities observed in TC. The previously reported observation of plaque rupture in TC seems to constitute an incidental finding. We suggest that the theory of aborted myocardial infarction as the underlying cause of TC should be abandoned once and for all. Copyright © 2010 Wiley Periodicals, Inc.

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Section: Discussionmentioning

confidence: 99%

Takotsubo Cardiomyopathy Is Not Due to Plaque Rupture: An Intravascular Ultrasound Study

Haghi

Roehm

Hamm

et al. 2010

Clinical Cardiology

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“…The akinesia is more extensive than the area supplied by any one coronary vessel (21). Occasionally, a left ventricular intraventricular gradient with high velocity in the basal segments may be detected (12,41). The apical ballooning regresses during follow-up, and normalization of the echocardiogram is usually seen within four to eight weeks.…”

Section: Laboratory Findingsmentioning

confidence: 99%

Transient left ventricular dysfunction (tako-tsubo phenomenon): Findings and potential pathophysiological mechanisms

Stöllberger

Finsterer

Schneider³

2006

Canadian Journal of Cardiology

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“…From the viewpoint of these pathophysiological findings, beta-blocker was a promising treatment. In fact, Villareal et al (20) have previously reported that intravenous beta-blocker abolishes left ventricular outflow obstruction in 3 patients with anteroapical myocardial stunning which is probably the same as takotsubo-like left ventricular dysfunction. However, this complication was transient, and beta-blocker might make heart failure worse through a negative inotropic effect.…”

Section: Discussionmentioning

confidence: 99%