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Coronary microvascular dysfunction in Takotsubo syndrome and associations with left ventricular function
Christina Ekenbäck1,2, Jannike Nickander3, Fadi Jokhaji2
1Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden.
ESC Heart Failure
|May 23, 2023
Summary
Coronary microvascular dysfunction (CMD) is prevalent in Takotsubo syndrome (TTS) and more common than in ischemia with no obstructive coronary arteries (INOCA). CMD severity in TTS correlates with left ventricular function but not coronary atherosclerosis.
Area of Science:
- Cardiology
- Vascular Biology
- Cardiac Imaging
Background:
- Coronary microvascular dysfunction (CMD) is increasingly recognized as a significant factor in the pathophysiology of Takotsubo syndrome (TTS).
- Understanding the extent and characteristics of CMD in TTS is crucial for elucidating disease mechanisms and guiding treatment strategies.
Purpose of the Study:
- To compare the prevalence and severity of CMD in patients with TTS versus those with ischemia and no obstructive coronary arteries (INOCA).
- To investigate the relationship between CMD and clinical parameters, left ventricular function, and coronary atherosclerosis in TTS patients.
Main Methods:
- A prospective study involving 27 female TTS patients and a matched INOCA cohort.
- Invasive assessment of coronary microvascular function using index of microcirculatory resistance (IMR), coronary flow reserve (CFR), and resistive reserve ratio (RRR).
- Evaluation of left ventricular function (echocardiography, CMR) and coronary atherosclerosis (IVUS-NIRS) in TTS patients.
Main Results:
- Higher incidence of CMD in TTS patients (78%) compared to INOCA (44%), with significantly worse microvascular parameters (higher IMR, lower CFR, lower RRR).
- Apical TTS phenotype exhibited more severe CMD (higher IMR, lower CFR/RRR) and impaired left ventricular strain compared to midventricular TTS.
- CMD parameters (CFR, RRR) correlated with left ventricular ejection fraction and volumes but showed no association with coronary atherosclerosis.
Conclusions:
- Coronary microvascular dysfunction is a common and significant finding in TTS, occurring more frequently and severely than in INOCA.
- CMD in TTS is linked to impaired left ventricular function, particularly in the apical variant, but is independent of coronary atherosclerosis.
- These findings reinforce the role of CMD as a central pathophysiological mechanism in Takotsubo syndrome.
Keywords:
Cardiovascular magnetic resonance imagingCoronary flow reserveCoronary microvascular dysfunctionIndex of microcirculatory resistanceIschaemia and no obstructive coronary arteriesTakotsubo syndromeMore Related Videos
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