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Coronary artery disease in takotsubo cardiomyopathy
Dariusch Haghi1, Theano Papavassiliu, Karsten Hamm
1I Medical Department, University Hospital Mannheim, Mannheim, Germany. dariush.haghi@med.ma.uni-heidelberg.de
Insights
Takotsubo cardiomyopathy (TC) and coronary artery disease (CAD) can coexist. Diagnosing TC should not be excluded solely based on the presence of CAD, necessitating individual patient assessment.
Area of Science:
- Cardiology
- Cardiovascular Medicine
- Clinical Research
Background:
- Coronary artery disease (CAD) is typically an exclusion criterion for diagnosing takotsubo cardiomyopathy (TC).
- However, TC and CAD can occur concurrently, challenging traditional diagnostic approaches.
Purpose of the Study:
- To investigate the potential overlap between takotsubo cardiomyopathy and coronary artery disease.
- To evaluate the justification for excluding TC diagnosis based solely on incidental CAD findings.
Main Methods:
- Retrospective analysis of 821 patients undergoing urgent left heart catheterization for suspected acute coronary syndrome.
- Evaluation of four patients with a final diagnosis of TC and significant left anterior descending artery stenosis (50-75%).
- Review of previous coronary angiograms and performance of intravascular ultrasound in select cases.
Main Results:
- Four patients met the inclusion criteria for concurrent TC and significant CAD.
- Intravascular ultrasound in two patients revealed negative remodeling without signs of plaque rupture or dissection.
- No changes in lesion appearance were noted on previous angiograms for two patients.
Conclusions:
- Takotsubo cardiomyopathy and coronary artery disease are not mutually exclusive.
- Excluding TC diagnosis based solely on incidental CAD is not always appropriate.
- A case-by-case evaluation is recommended for patients with suspected TC and coexisting CAD.
Background:
Significant coronary artery disease (CAD) is generally considered as an exclusion criterion for the diagnosis of takotsubo cardiomyopathy (TC). However, this may not be justified in all cases, because TC and CAD may coincide.
Methods And Results:
Among 821 consecutive patients who underwent urgent left heart catheterization for suspected acute coronary syndrome between December 2004 and August 2006 those with a final diagnosis of TC who also had a stenotic lesion (diameter stenosis on quantitative coronary angiography >50% and <75%) of the left anterior descending artery were evaluated. Four patients met the inclusion criteria. Previous coronary angiograms were available for 2 of these patients and showed no change in the angiographic appearance of the lesions. Intravascular ultrasound study was performed in the other 2 patients and demonstrated negative remodeling and no signs of plaque rupture, thrombus, positive remodeling or intimal dissection.
Conclusions:
The present study supports the notion that TC and CAD are not mutually exclusive disease entities. Excluding the diagnosis of TC on the sole basis of an incidental finding of CAD may not be justified in all cases. Rather, a case-by-case decision process seems more appropriate.
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