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[Evaluation of coronary flow reserve using Doppler guide wire in patients with ampulla cardiomyopathy: three case
Shiro Yanagi1, Keiji Nagae, Kaoru Yoshida
1Department of Cardiology, Seichokai Fuchu Hospital, Hiko-cho 1-10-17, Izumi, Osaka 594-0076.
Insights
Takotsubo cardiomyopathy, a form of heart muscle dysfunction, can present with reduced coronary flow reserve despite normal epicardial arteries. This coronary microvascular impairment may improve over time.
Area of Science:
- Cardiology
- Cardiovascular Physiology
Background:
- Takotsubo cardiomyopathy (TTC) is characterized by transient left ventricular dysfunction.
- Epicardial coronary arteries are typically normal in TTC, suggesting involvement of the microvasculature.
Observation:
- Coronary flow velocity was measured using Doppler guide wire in three TTC patients.
- Coronary angiography showed no significant stenosis, and left ventriculography revealed typical apical ballooning.
Findings:
- While coronary flow velocity patterns were normal, coronary flow reserve (CFR) was reduced in all major coronary arteries (LAD, LCx, RCA) after adenosine administration.
- In follow-up studies, left ventricular function improved, and CFR normalized in one patient.
Implications:
- These findings suggest that coronary microvascular dysfunction is a key feature of Takotsubo cardiomyopathy.
- Reduced coronary flow reserve may be reversible, indicating potential for recovery of cardiac function.
Abstract:
Coronary flow velocity recordings were obtained in three patients with ampulla (Takotsubo) cardiomyopathy using Doppler guide wire. Immediately after admission, coronary angiography demonstrated no significant stenosis and normal coronary flow in the epicardial coronary artery. Left ventriculography showed abnormal wall motion of the left ventricle mimicking ampulla shape in all patients. The coronary flow velocity pattern was normal, but coronary flow reserve of the left anterior descending coronary artery was decreased by adenosine administration in all patients. The coronary flow reserve in the left circumflex and right coronary artery also decreased. Cardiac catheterization was performed during the follow-up period in two patients. Left ventriculography revealed almost normal wall motion of the left ventricle. The coronary flow reserve normalized in one patient.