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Coronary microvascular dysfunction in Takotsubo syndrome: cause or consequence.

Shams Y-Hassan1

  • 1Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska Institutet and Karolinska University Hospital Stockholm, Sweden.

American Journal of Cardiovascular Disease
|June 4, 2021
PubMed
Summary

Coronary microvascular dysfunction (CMVD) may not be the primary cause of Takotsubo syndrome (TS). Evidence suggests CMVD is a secondary effect, with specific patterns observed in the left anterior descending artery distribution.

Keywords:
Takotsubo syndromecardiac crampmicrovascular dysfunctionmyocardial stunningneurocardiogenic syndrome

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Area of Science:

  • Cardiology
  • Pathophysiology
  • Cardiac Syndromes

Background:

  • Takotsubo syndrome (TS) is an acute cardiac condition with transient myocardial stunning.
  • Coronary microvascular dysfunction (CMVD) is a proposed pathological mechanism for TS.
  • Existing research presents conflicting evidence regarding CMVD's role in TS etiology.

Purpose of the Study:

  • To review evidence challenging CMVD as the primary cause of TS.
  • To support the hypothesis that CMVD is a secondary phenomenon in TS.
  • To explain the localized prevalence of CMVD in TS, particularly in the LAD distribution.

Main Methods:

  • Literature review of studies investigating CMVD in Takotsubo syndrome.
  • Analysis of invasive and non-invasive diagnostic findings.
  • Evaluation of the reversibility of CMVD in relation to myocardial function.

Main Results:

  • Inconsistent findings regarding the presence and extent of CMVD in TS patients.
  • CMVD signs are not uniformly present across all coronary artery territories.
  • CMVD is more frequently observed and pronounced in the left anterior descending artery (LAD) distribution.
  • CMVD in TS demonstrates reversibility, mirroring improvements in myocardial wall motion.

Conclusions:

  • Substantial evidence challenges CMVD as the primary driver of Takotsubo syndrome.
  • CMVD is likely a secondary or epiphenomenal event in the pathophysiology of TS.
  • A clear explanation is provided for the predominant CMVD findings in the LAD territory during TS.