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Prognostic Value of Microvascular Resistance at Rest in Patients With Takotsubo Syndrome
Jordi Sans-Roselló1, Estefanía Fernández-Peregrina2, Albert Duran-Cambra3
1Department of Cardiology, Parc Taulí Hospital Universitari, Sabadell, Barcelona, Spain; Department of Medicine, School of Medicine, Universidad Autonoma de Barcelona, Barcelona, Spain; Section of Interventional Cardiology, MedStar Washington Hospital Center, Washington, DC, USA.
Background:
Microvascular resistance (MR) is increased in takotsubo syndrome (TTS) and can be assessed by a validated pressure-wire-free tool called nonhyperemic angiography-derived index of microcirculatory resistance (NH-IMRangio).
Objectives:
The authors aimed to study whether the degree and extent of an altered MR in TTS patients were associated with 1-year prognosis.
Methods:
The authors recruited 181 consecutive patients with TTS who underwent cardiac angiography. Impaired MR was defined as an NH-IMRangio ≥25. The degree and extent of impaired MR were assessed by the value of maximum NH-IMRangio in each major coronary artery and by the number of coronary arteries with an NH-IMRangio ≥25, respectively. Major adverse cardiac events (MACE) were a composite of cardiovascular death, heart failure event, acute myocardial infarction, and hospitalization for symptomatic arrhythmias.
Results:
A total of 166 patients had NH-IMRangio available. The mean age was 74.8 years, and 83% were women. The rate of MACE at 1 year was 21.1%, mainly due to heart failure events that were generally mild. Kaplan-Meier curves showed higher rates of MACE in patients with higher NH-IMRangio (28.9% vs 13.3%; P = 0.019) and in those with 3 coronary arteries with increased MR compared to those with 2 or 1 affected arteries (33.3% vs 15.9% vs 9.5%; P = 0.040 and P = 0.040, respectively). After a multivariable Cox regression analysis, higher values of NH-IMRangio (HR: 3.41 [95% CI: 1.54-7.52]; P = 0.002) and the presence of 3 coronary arteries with increased MR (HR: 6.39 [95% CI: 1.46-27.87]; P = 0.014) were independent predictors of MACE in TTS patients.
Conclusions:
The degree and extent of an impaired MR assessed by a validated pressure-wire-free tool were independent predictors of MACE at 1-year follow-up in TTS patients.
Insights
Microvascular resistance (MR) in takotsubo syndrome (TTS) predicts prognosis. Higher MR values and more affected coronary arteries are linked to increased major adverse cardiac events (MACE) within one year.
Area of Science:
- Cardiology
- Cardiovascular Research
- Medical Diagnostics
Background:
- Takotsubo syndrome (TTS) is characterized by increased microvascular resistance (MR).
- Nonhyperemic angiography-derived index of microcirculatory resistance (NH-IMRangio) offers a pressure-wire-free method to assess MR.
Purpose of the Study:
- To investigate the association between the degree and extent of altered MR in TTS patients and their 1-year prognosis.
- To determine if NH-IMRangio can predict major adverse cardiac events (MACE) in TTS.
Main Methods:
- 181 consecutive TTS patients undergoing cardiac angiography were recruited.
- Impaired MR was defined as NH-IMRangio ≥25. Degree and extent were assessed by maximum NH-IMRangio values and the number of affected coronary arteries.
- MACE included cardiovascular death, heart failure, myocardial infarction, and symptomatic arrhythmia hospitalizations.
Main Results:
- In 166 patients with available NH-IMRangio data, 1-year MACE rate was 21.1%, primarily heart failure events.
- Higher NH-IMRangio values (28.9% vs 13.3%; P=0.019) and three affected coronary arteries (33.3% vs 15.9%/9.5%; P=0.040) correlated with higher MACE rates.
- Multivariable Cox regression identified higher NH-IMRangio (HR: 3.41) and three affected arteries (HR: 6.39) as independent MACE predictors.
Conclusions:
- The degree and extent of impaired MR, assessed by NH-IMRangio, are independent predictors of 1-year MACE in TTS patients.
- NH-IMRangio is a valuable tool for risk stratification in TTS.
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