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Updated: Jun 12, 2026

Ultrasonic Assessment of Myocardial Microstructure
Published on: January 14, 2014
Takotsubo cardiomyopathy is not due to plaque rupture: an intravascular ultrasound study
Dariusch Haghi1, Stefanie Roehm, Karsten Hamm
1First Department of Medicine, University Medical Centre and Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany. dariush.haghi@med.ma.uni-heidelberg.de
Insights
Plaque rupture and coronary thrombosis do not cause Takotsubo cardiomyopathy (TC). Intravascular ultrasound (IVUS) found no evidence of these in TC patients, suggesting the theory of aborted myocardial infarction in TC is incorrect.
Area of Science:
- Cardiology
- Cardiovascular Research
- Medical Imaging
Background:
- Takotsubo cardiomyopathy (TC) is a condition with proposed mechanisms involving plaque rupture and transient coronary thrombosis.
- A fast-dissolving clot causing coronary occlusion is one such proposed mechanism for TC.
Purpose of the Study:
- To investigate the hypothesis that transient coronary thrombosis underlies Takotsubo cardiomyopathy.
- To seek evidence for plaque rupture as a cause of TC using intravascular ultrasound (IVUS).
Main Methods:
- Retrospective analysis of 10 patients diagnosed with Takotsubo cardiomyopathy (TC).
- All identified patients underwent intravascular ultrasound (IVUS) during initial left heart catheterisation.
- Analysis of the left anterior descending artery, including lumen diameter, vessel diameter, and plaque/media volume.
Main Results:
- Intravascular ultrasound (IVUS) analysis of the left anterior descending artery revealed no instances of plaque rupture.
- No evidence of positive remodeling or presumed intracoronary thrombus was observed in any of the studied patients.
- Median plaque and media volume were 90.9 mm(3) (IQR: 70.4-101.4 mm(3)).
Conclusions:
- Plaque rupture does not explain the regional wall motion abnormalities seen in Takotsubo cardiomyopathy (TC).
- Previous reports of plaque rupture in TC patients may represent incidental findings.
- The theory of aborted myocardial infarction as the cause of TC should be reconsidered.
Background:
Plaque rupture with subsequent transient thrombotic coronary occlusion by a fast-dissolving clot is one of the proposed pathogenic mechanisms in Takotsubo cardiomyopathy (TC).
Hypothesis:
The aim of this study was to seek evidence for the hypothesis of transient coronary thrombosis as the underlying mechanism of TC by means of intravascular ultrasound (IVUS).
Methods:
In our database of 63 consecutive patients with TC we identified 10 patients (16%) who had undergone IVUS during their initial left heart catheterisation.
Results:
A median length of 67 mm of the left anterior descending artery was analyzed (interquartile range [IQR]: 63.3-70.1 mm). Median lumen diameter, median vessel diameter, median plaque and media volume were 2.9 mm (IQR: 2.7-3.1 mm), 4.2 mm (IQR: 3.8-4.4 mm), and 90.9 mm(3) (IQR: 70.4-101.4 mm(3)), respectively. Plaque rupture, positive remodeling, and presumed intracoronary thrombus were absent in all patients.
Conclusion:
In conclusion, plaque rupture does not account for the regional wall motion abnormalities observed in TC. The previously reported observation of plaque rupture in TC seems to constitute an incidental finding. We suggest that the theory of aborted myocardial infarction as the underlying cause of TC should be abandoned once and for all.
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