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Characteristics of coronary microcirculatory function in patients with Takotsubo syndrome
Giuseppina Novo1, Angelo Quagliana1, Dario Buccheri2
1Chair and Division of Cardiology, University of Palermo, Palermo, Italy.
Insights
Takotsubo syndrome (TS) involves altered coronary microcirculation, milder than microvascular angina (MA). A TIMI frame count (TFC) over 20 frames distinguishes TS patients from healthy individuals.
Area of Science:
- Cardiology
- Cardiovascular Research
- Medical Diagnostics
Background:
- Takotsubo syndrome (TS) is a cardiac condition with unclear pathogenesis.
- Investigating coronary microcirculatory function is crucial for understanding TS.
- Comparison with microvascular angina (MA) provides further insight.
Purpose of the Study:
- To characterize coronary microcirculatory function in TS patients.
- To compare microcirculation in TS patients with healthy controls and MA patients.
- To evaluate the diagnostic utility of TIMI frame count (TFC) in TS.
Main Methods:
- Enrolled 71 TS patients, 70 controls, and 71 MA patients.
- Assessed coronary microcirculation using TIMI frame count (TFC).
- Analyzed TFC values across different coronary arteries and patient groups.
Main Results:
- Significantly altered microcirculation in TS patients compared to controls (average TFC 25.70±5.34 vs. 16.70±3.26, P<0.001).
- TFC >20 frames effectively discriminated TS patients from controls (AUC 0.927).
- Microvascular dysfunction was diffuse in TS, comparable to MA but milder (P<0.046).
Conclusions:
- Coronary microcirculation in TS is diffusely affected, though milder than in MA.
- A TFC cut-off value of >20 frames can differentiate TS patients from those with normal microcirculation.
Background:
Takotsubo syndrome (TS) is a recently described cardiac syndrome whose pathogenesis is still unclear. We investigated the characteristics of coronary microcirculatory function in patients with TS through the analysis of the TIMI frame count (TFC) compared to normal subjects and with to subjects with microvascular angina (MA).
Methods:
We enrolled 71 TS patients (F:M =69:2, mean age of 65.27±9.53 years), 70 controls (F:M =34:36, mean age of 56.63±13.5 years) and 71 patients with MA, (F:M =69:2, mean age of 65.9±9.2 years). The assessment of the microcirculation was carried out through the TFC.
Results:
microcirculation was significantly altered in patients with TS compared with healthy controls [left anterior descending coronary artery (LAD) 25.16±6.91 vs. 17.30±3.76, P<0.001; circumflex artery (CX) 25.48±6.10 vs. 17.05±4.60, P<0.001; right coronary artery (RCA) 26.43±8.95 vs. 15.74±4.27, P<0.001, average TFC in TS 25.70±5.34 vs. 16,70±3.26, P<0.001). A TFC >20 frames was able to discriminate TS patients from controls with a specificity of 88.57% and sensitivity of 85.92% (AUC 0.927, P<0.0001). Microvascular dysfunction was diffuse in TS as well as in MA and slightly more severe in this last (mean TFC in MA 28.25±9.3 vs. 25.7±5.34 in TS, P<0.046).
Conclusions:
Coronary microcirculation in TS patients is diffuse and milder compared to MA patients. Cut-off values >20 frames discriminate between patients with normal microcirculation and patients with TS.
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