The Coronary Flow Reserve Is Transiently Impaired in Tako-Tsubo Cardiomyopathy: A Prospective Study Using Serial Doppler Transthoracic Echocardiography

Primary Coronary Microvascular Dysfunction

“…58 Thus, sustained intense coronary microvascular constriction or spasm, resulting in myocardial ischemia and stunning, may be responsible or contribute significantly to SRCM, at least in some patients. Accordingly, some reports have shown abnormal myocardial perfusion in the affected myocardial segments, 59 and CMVD has been documented by evidence of reduced CBF response to vasodilator stimuli 60,61 in the acute phase. Of note, CMVD was found to subside in a few weeks, paralleling clinical improvement 60,61 (Figure 6).…”

“…Accordingly, some reports have shown abnormal myocardial perfusion in the affected myocardial segments, 59 and CMVD has been documented by evidence of reduced CBF response to vasodilator stimuli 60,61 in the acute phase. Of note, CMVD was found to subside in a few weeks, paralleling clinical improvement 60,61 (Figure 6). Thus, although further studies are needed to clarify the exact role of CMVD in SRCM, preliminary data suggest that acute severe coronary microvascular constriction can contribute significantly to this clinical syndrome.…”

“…60,61 Il y a lieu de noter que cette DMVC s'est normalisée en quelques semaines, parallèlement à l'amélioration clinique 60,61 ( Figure 6). Ainsi, bien que d'autres études soient nécessaires pour clarifier le rôle exact joué par la DMVC dans la CMS, les données préliminaires suggèrent que l'intense constriction aiguë des microvaisseaux coronaires pourrait fortement contribuer à ce syndrome clinique.…”

Transient Cardiac Ballooning—The Syndrome

“…A recent study measured patients' CFR in acute stage and compared that to CFR after recovery phase and discovered that there was significant improvement in the recovery phase in the same patients correlating well with improvement in LV wall motion and LVEF. 49 This gives credence to the microcirculatory postischemic stunning hypothesis at least as a probable concurring phenomenon. A potential therapeutic study protocol based on the above platform could be the use of dipyridamole during LHC to increase adenosine diphosphate and vasodilate the microcirculation, 50 once the epicardial coronary angiogram is found to be nonobstructive, while still in the acute phase of the syndrome.…”

Transesophageal Echocardiographic Evaluation of Atherosclerosis

“…69) Youn et al 70) reported that CFR using TTE is useful for the detection of microvasculature-induced ischemia; other investigators have reported on the clinical impact of CFR by TTE in the setting of cardiomyopathy, a kind of microvascular disease. [71][72][73] However, CFR using TTE has mainly been focused on the LAD. Simultaneous measurement of the CFR of the LAD, LCX, and RCA requires considerable time, and this technique is not suitable in clinical settings.…”