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Updated: Jun 23, 2025
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Oxygenation-sensitive Cardiac MRI with Vasoactive Breathing Maneuvers for the Non-invasive Assessment of Coronary Microvascular Dysfunction
Published on: August 17, 2022
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Coronary microvascular dysfunction in patients with Takotsubo syndrome
Aviel Shetrit1, Ophir Freund1, Ariel Banai1
1Departments of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel.
Heart & Lung : the Journal of Critical Care
|June 23, 2024
Summary
Coronary microvascular dysfunction (CMD) is common in Takotsubo syndrome (TTS). Invasive measures like Resistive Reserve Ratio (RRR) may help diagnose CMD in TTS patients, who often show improved heart function over time.
Area of Science:
- Cardiology
- Cardiovascular Research
- Medical Diagnostics
Background:
- Takotsubo syndrome (TTS) pathophysiology is not fully understood.
- Coronary microvascular dysfunction (CMD) is a suspected but understudied mechanism in TTS.
Purpose of the Study:
- To investigate the presence and characteristics of CMD in patients diagnosed with TTS.
- To evaluate invasive microvascular function parameters in TTS patients.
Main Methods:
- Invasive coronary angiography with fractional flow reserve, Coronary Flow Reserve (CFR), Index of Microcirculatory Resistance (IMR), and Resistive Reserve Ratio (RRR) measurements.
- Echocardiography at admission and 6-week follow-up.
Main Results:
- 83% of TTS patients exhibited at least one abnormal microvascular function parameter.
- Abnormalities included low CFR (67%), high IMR (60%), and low RRR (83%).
- Left ventricular ejection fraction improved significantly by 6 weeks (40% to 57%).
Conclusions:
- CMD is prevalent in most TTS patients.
- RRR may be a sensitive indicator for CMD in TTS.
- Microvascular function's role in TTS may depend on clinical presentation.
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