Neuropeptide Y-induced coronary microvascular dysfunction: A significant contributor to the adverse outcomes in stress cardiomyopathy?

Coronary slow flow in the setting of Tako-tsubo cardiomyopathy: A causative factor? An innocent bystander? Or a prognostic sign?

“…Therefore, beyond serving as a potential contributor to the pathogenesis, there might exist further implications of CSF phenomenon in the setting of TTC. Accordingly, we would like to draw particular attention to the prognostic relevance of this phenomenon in the setting of TTC, as mentioned in our previous report [5], on top of a variety of potential risk stratifies, and would like to have further information regarding a few specific points in the interesting study of Khalid N et al [4].…”

“…We totally agree with the authors on the usefulness of TFC in the evaluation of CSF associated with microvascular dysfunction in the setting of TTC. On the other hand, CSF phenomenon due to microvascular dysfunction is not a routine finding, and is encountered only in a small portion of patients with TTC in clinical practice [5] potentially contributing to the characteristic myocardial stunning, to some extent, in these patients. This might potentially imply that TTC patients with a CSF pattern, besides being more prone to ischemic events (arrhythmias, etc.)…”

“…This might potentially imply that TTC patients with a CSF pattern, besides being more prone to ischemic events (arrhythmias, etc.) [5] and sudden cardiac death (SCD), etc, may also be more likely to develop acute heart failure signs and symptoms possibly as a result of significant reduction in their left ventricular systolic and diastolic functions. Therefore, beyond serving as a potential contributor to the pathogenesis, there might exist further implications of CSF phenomenon in the setting of TTC.…”

“…Currently, the prognosis of TTC is not regarded so benign as was previously accepted [5] since a variety of studies reported considerable rates of malign arrhythmias and mortality [6] indicating the need for proper risk stratification of these patients, particularly in the acute setting. The presence of clinical heart failure and a variety of indices including ratio of copeptin/NT-pro BNP have been suggested to have a prognostic value in patients with TTC [7].…”

“…As another prognostic index, corrected QT interval (QTc) prolongation on electrocardiogram (ECG) (a well known parameter of sympathetic discharge) was also shown to be associated with cardiovascular arrest due to induction of polymorphic ventricular tachycardia (PVT) during the early course of TTC (particularly within the first few days) [9]. Taken together, a variety of prognostic indices have been proposed in the setting of TTC [5][6][7][8][9]. However, combined use of these indices (not a single marker) might help better risk stratification and management of patients with TTC.…”