Role of myocardial bridging in the apical localization of stress cardiomyopathy

Abstract

Our data suggest that myocardial bridging possibly enhanced by catecholamines during stress may contribute, in association with left ventricular hypertrophy, to the preferential apical localization of the apical ballooning syndrome. Further investigations are necessary to confirm

The Tako-Tsubo syndrome: No evidence of peripheral endothelial or microvascular dysfunction

“…This observation is not compatible with the hypothesis that catecholamine-induced endothelial and/or microvascular toxicity might be an important pathophysiological component of Tako-Tsubo cardiomiopathy. In contrast, the presence of a myocardial bridge, possibly associated with focal abnormalities in the myocardial architecture [4], was described in previous case reports [5]. This characteristic, also present in our patient, might help explain why the akinesia is limited to the apical segments of the left ventricle in this condition.…”

Takotsubo cardiomyopathy or transient left ventricular apical ballooning syndrome: A systematic review

“…11 studies from Asia [18][19][20][21][22][23][24][25][26][27][28] contributed 249 patients (44.2%), 14 studies from Europe [29][30][31][32][33][34][35][36][37][38][39][40][41][42] 231 patients (41.0%), and 3 studies from North America [43][44][45] 83 patients (14.7%). Twelve studies were performed prospectively [20,23,25,27,[30][31][32]35,38,41,43,44], seven studies reported retrospective data [19,21,22,24,28,33,34] and nine studies were unspecified [18,26,29,…”

“…Transient prolonged QT intervals were consistently described in TLVABS. Mean/median QTc in seven studies [20,22,28,31,39,40,43] was ranging from 445.8 to 542 ms. Mental stress and autonomic changes have been demonstrated to precipitate prolongation of ventricular repolarization duration [46] and prolong QT interval [47], respectively.…”

“…Provocation of coronary artery vasospasms by either acetylcholine or ergovine was assessed in nine studies [18][19][20][21]23,26,27,30,40] and collectively encountered in 34 of 123 patients (27.6%, 95% CI: 19.7-35.5%) with variable frequency ranging from 0 to 71.4%.…”

“…Transient intraventricular pressure gradients between the apex and the base reflecting dynamic left ventricular outflow tract obstruction were described in eight studies [5,19,36,37,[39][40][41]44] in collectively 27 of 165 patients (16.4%, 95% CI: 10.7-22.0%, range 10-22.7%).…”