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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

Clinical Cardiology
|June 1, 2010
PubMed

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.
Abstract

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