Impaired coronary microvascular reactivity in women with apical ballooning syndrome (Takotsubo/stress cardiomyopathy)

Patel, Sandeep M.; Lerman, Amir; Lennon, Ryan J.; Prasad, Abhiram

doi:10.1177/2048872613475891

Cited by 85 publications

(60 citation statements)

References 19 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Epicardial coronary artery vasospasm and consequently regionally stunned myocardium may induce reversible LV wall motion abnormalities (1). Several studies investigating vasospastic provocation in the acute phase of TTC demonstrated positive results (10-43%) but not in all TTC patients (4,20). Various studies have reported that the endothelin levels are higher in patients with TTC than those with AMI (21).…”

Section: Introductionmentioning

confidence: 95%

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Izumo¹,

Akashi²

2018

Cardiovasc. Diagn. Ther.

View full text Add to dashboard Cite

Takotsubo cardiomyopathy (TTC) is newly-described secondary cardiomyopathy characterized by transient left ventricular (LV) dysfunction, which is increasingly recognized in the field of cardiology.TTC occurs in approximately 2% of the patients with acute coronary syndrome. Its onset is rare; however, its specific features play a crucial role in diagnosing the chest pain in clinical practice. TTC has generally favorable outcome with rapid recovery of LV function; however, an increasing evidence suggests that it should be regarded as a more serious acute cardiac disorder with a variety of complications. Owing to its widespread availability, even in emergency settings, transthoracic echocardiography plays a key role in the diagnostic assessment of TTC and contributes to an increased number of disease detection and incidence reports in contemporary clinical practice. This review focuses on the role of echocardiography in understanding the clinical prognostic implications in patients with TTC.

show abstract

Section: Introductionmentioning

confidence: 95%

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

Izumo¹,

Akashi²

2018

Cardiovasc. Diagn. Ther.

View full text Add to dashboard Cite

show abstract

“…Vasospastic provocation has been studied during the acute phase, with evidence in 10-43% patients in various series 58,59 . In non-Japanese populations, especially when performed in the convalescent phase or later, epicardial coronary vasospasm is not a common finding, whereas microvascular dysfunction was more common 60 . A review of 9 cohort studies concluded provocation-induced vasospasm was present in 34 of 123 patients studied (27.6%) 61 .…”

Section: Acute Multivessel Coronary Spasmmentioning

confidence: 99%

Epidemiology and pathophysiology of Takotsubo syndrome

2015

View full text Add to dashboard Cite

Takotsubo syndrome is an acute cardiac syndrome first described in 1990 and characterized by transient left ventricular dysfunction affecting more than one coronary artery territory, and often in a circumferential apical, mid-ventricular or basal distribution. A number of pathophysiological explanations for this syndrome with its intriguing appearance have been proposed, and there is a growing awareness that these are not mutually exclusive, and that the reversible apical myocardial dysfunction observed could result from more than one pathophysiological phenomenon. The pathophysiology of takotsubo syndrome is complex, with integration of both neuroendocrine physiology involving the cognitive centres of the brain and hypothalamic-pituitary-adrenal axis, and the cardiovascular responses to the sudden sympathetic activation and surge in circulating catecholamines. The latter have been explored in detail, starting with the histological findings at biopsy, with the multiple morphological changes seen in the myocardium matching those seen after established catecholamine cardiotoxic effects. Clinically, both the acute prognosis and recurrence rate are unfortunately worse than previously reported. It is clear that the modern cardiology community has much still to learn regarding the epidemiology and the underlying pathophysiology of this fascinating condition in order to improve diagnostic and treatment pathways. 3 Key points Approximately 2% of all patients presenting to the hospitals with suspected acute coronary syndrome are usually identified with takotsubo syndrome. There is a predominance in post-menopausal women compared to men or younger women. Both the acute and long-term mortality are higher than previously recognized.The cumulative incidence of recurrence increased from 1.2% at first 6 months to nearly 5% at 6 years, and there is no current evidence to support treatment with any specific to prevent recurrence. Systemic surges in catecholamines may cause vascular effects including acute coronary vasospasm and severe acute hypertension due to acute peripheral vasospasm followed by later peripheral vasodilation and hypotension. In the clinical setting, profound hypotension and cardiogenic shock is a common complication, however, it is not solely related to the extent of impairment of left ventricular (LV) systolic function, and thus probably relates in part to inappropriate peripheral vasodilation. Biopsies during acute takotsubo syndrome are characterized by multiple morphological changes that are similar to those after catecholamine cardiotoxic effects supporting a direct effect in addition to the vascular influences. The apical myocardium of the left ventricle has the highest density of β-adrenergic receptors (βAR), and is therefore most sensitive to circulating catecholamines.

show abstract

“…There is evidence for increased adrenergic activity with microvascular spasm and subsequent reduced or sluggish blood flow [6][7][8]. Reduced or impaired microvascular vasoreactivity has been measured in clinical studies where measurements are generally recorded in patients after the heart is already damaged.…”

Section: Editorialmentioning

confidence: 99%

“…We would like to open a discussion around the prevailing opinions and the available evidence that this cardiomyopathy is the result of an adrenaline surge, with stress causing microvascular dysfunction on a wide scale [6][7][8]. Atherosclerotic plaque rupture or erosion with in situ thrombosis resulting in ST elevation myocardial infarction (STEMI or acute heart attack) has been considered a distinct event, unrelated to Tako-tsubo cardiomyopathy.…”

Section: Editorialmentioning

confidence: 99%