Takotsubo Cardiomyopathy as an Underlying Mediator of Myocardial Infarction with Normal Coronary Arteries

Abstract

Objective: The purpose of the present study was to describe our experience with myocardial infarction with normal coronary arteries (MINCA) with regards to the prevalence, clinical characteristics, possible underlying etiologies (including Takotsubo cardiomyopathy, TCM) and the short- and long-term outcomes associated with this condition. Methods: We retrospectively analyzed the records of 596 consecutive patients presenting with acute myocardial infarction over a 4-year period and identified 24 patients (14 female, 10 male) with angiographically normal coronary arteries. Demographic and clinical variables and outcomes were reviewed. Results: Mean patient age was 59 ± 20 years. The presumed MINCA mechanism was TCM in 10 patients (41.7%), probable myocarditis in 5 (20.8%), coronary spasm in 4 (16.7%), coronary thrombus in 3 (12.5%) and aortic dissection in 2 patients (8.3%). After a mean follow-up of 19 ± 14 months, 2 patients with probable myocarditis had died of cardiovascular causes, 1 patient with aortic dissection had died due to sepsis after surgery and 1 patient with TCM had died of noncardiovascular causes 2 years after discharge. Conclusion: In this study, we found that MINCA occurred in 4% of patients with acute myocardial infarction undergoing emergent coronary angiography, with the most frequent underlying mechanism being TCM.

Transient Mid-Ventricular Ballooning Syndrome: An Atypical Variant of Stress Cardiomyopathy

“…Other atypical variants include the basal variant (2.2%) affecting basal segments, the focal variant (1.5%) affecting an isolated segment, and rarely a global variant with hypokinesis of all ventricular segments [ 15 , 16 ]. The atypical variants tend to present in younger patients with a lower prevalence of hypertension [ 17 ]. The stressor type itself appears to modify the pattern of LV dysfunction, with more frequent surgical and disease-related stressors in patients with the atypical variants [ 18 ].…”

Does Atherosclerosis Protect from Takotsubo?

“…We read with interest the article by Chen et al [1] , who performed a nice retrospective study on patients with myocardial infarction with normal coronaries (MINCA). Takotsubo cardiomyopathy (TCM) is becoming increasingly important and the findings of the authors are in keeping with previous studies, which have shown TCM to be present in about 2% of patients with acute coronary syndrome (ACS) [2,3] .…”

“…Chen et al [1] and a number of other investigators have used the Mayo Clinic criteria reported by Prasad et al [4] to confirm the diagnosis of TCM. According to these criteria, one of the main requirements to confirm the diagnosis of TCM is the exclusion of obstructive coronary ar-the sole basis of incidental finding of CAD is not justified.…”