Prevalence of incidental coronary artery disease in tako-tsubo cardiomyopathy

Kurisu, Satoshi; Inoue, Ichiro; Kawagoe, Takuji; Ishihara, Masaharu; Sakai, Yuji; Nakama, Yasuharu; Maruhashi, Tatsuya; Kagawa, Eisuke; Dai, Kazuoki; Matsushita, Junichi; Ikenaga, Hiroki

doi:10.1097/mca.0b013e3283299260

Cited by 92 publications

(66 citation statements)

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“…12 Therefore, with obstructive coronary atherosclerotic disease ruled out as a cause of TTC, the coronary microcirculation has been identified as a suitable candidate that may play a central role in the pathophysiology of the syndrome. As is known, the coronary microcirculation, involving the coronary pre-arterioles and arterioles (<500 μm in diameter), modulates coronary blood flow in response to neural, mechanical and metabolic factors and its dysfunction compromises myocardial perfusion.…”

Section: Microvascular Dysfunction In Ttcmentioning

confidence: 99%

Role of Coronary Microvascular Dysfunction in Takotsubo Cardiomyopathy

Vitale¹,

Rosano

Kaski

2016

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp LV systolic function over a period of days or few weeks. The long-term prognosis of TTC is generally favorable, even though complications (ie, acute heart, cardiogenic shock, arrhythmias etc) may occur during the acute phase of TTC in some patients. The rate of cardiovascular death ranges from 0% to7%. 10, 11 The etiology of TTC has not been established as yet, and several and heterogeneous pathophysiologic mechanisms have been proposed to explain its occurrence, as summarized in Table 2. The notion that coronary microvascular dysfunction may have a pathogenic role in TTC is currently gaining acceptance and this review aims to critically assess the potential role of coronary microvascular abnormalities in the pathogenesis of this intriguing syndrome. Microvascular Dysfunction in TTCThe vast majority of patients presenting with TTC have angiographically normal coronary arteries or nonobstructive CAD (<75% stenosis). 12 Therefore, with obstructive coronary atherosclerotic disease ruled out as a cause of TTC, the coronary microcirculation has been identified as a suitable candidate that may play a central role in the pathophysiology of the syndrome. As is known, the coronary microcirculation, involving the coronary pre-arterioles and arterioles (<500 μm in diameter), modulates coronary blood flow in response to neural, mechanical and metabolic factors and its dysfunction compromises myocardial perfusion. With the use of invasive and noninvasive methods of assessing coronary artery microvascular abnormalities, several authors have reported data that akotsubo cardiomyopathy (TTC), also known as "transient left ventricular (LV) apical ballooning syndrome" or "stress-induced cardiomyopathy", is an acute clinical condition mimicking acute myocardial infarction. 1,2 Initially described in 1991 by Sato et al in Japan, 3 the condition has now become a relatively frequent occurrence worldwide. The typical presentation of TTC with chest pain, ischemic ECG changes and acute congestive heart failure leads to the initial diagnosis of anterior wall myocardial infarction. The typical angiographic (or echocardiographic) appearance with bulging of the LV apex ("apical ballooning") and hypercontractility of the basal segments of the LV has given TTC its name; that is, "takotsubo", the Japanese word for octopus pot. 4 The LV systolic dysfunction that characterizes TTC is often associated with diagnostic ST-segment elevation in the anterior ECG leads and increased cardiac troponin levels, albeit in the absence of obstructive epicardial coronary artery disease (CAD). In most cases, the clinical onset of TTC appears to be triggered by an acute emotional and/or physical stress, albeit in many cases the iatrogenic effect of certain pharmacological agents has been identified as a trigger (Table 1). 5,6 Recurrent episodes of TTC are not common, but cases have been described. 7, 8 The prevalence of TTC has been reported to be approximately 1-3% ...

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Section: Microvascular Dysfunction In Ttcmentioning

confidence: 99%

Role of Coronary Microvascular Dysfunction in Takotsubo Cardiomyopathy

Vitale¹,

Rosano

Kaski

2016

Circ J

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“…Because most patients have several coronary risk factors, including advanced age, it is natural that obstructive coronary artery disease is found incidentally; in our experience, in 10% of Japanese patients with takotsubo cardiomyopathy. 19 When obstructive coronary artery disease exists in the wrapped left anterior descending artery, it should be carefully assessed whether it is associated with RWMA in the apical segment.…”

Section: Coronary Angiographymentioning

confidence: 99%

Clinical Management of Takotsubo Cardiomyopathy

Kurisu

Kihara

2014

Circ J

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Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp stress such as asthma attack or non-cardiac surgery have been identified in previous cases. 3 These stressors are common events that anyone may experience. Men account for a minority of cases; reports range from 4% to 13%. 6-8 In men, physical stress rather than emotional stress is much more associated with the occurrence. 7,8 ElectrocardiographyCommon abnormalities on the initial ECG are ST-segment elevation, negative T wave and subsequent QT interval prolongation (Figure 2). 3-5,9-11 There is a significant variability in frequency because these ECG changes are time-dependent. 12, 13 The typical time course of the ECG is as follows. 12 ST-segment elevation usually occurs shortly after onset. Negative T wave deepens progressively to its first negative peak, which occurs at approximately 3 days. The negative T wave becomes shallow for several days and then deepens, the second negative peak occurring at approximately 2 weeks. QT interval becomes prolonged progressively as the negative T wave deepens. These ECG changes are found in takotsubo cardiomyopathy as well as AMI, and the differential diagnosis is clinically important for appropriate management. Ogura et al reported that the absence of reciprocal changes, the absence of abnormal Q wave and the sum of ST-segment elevation in leads V4-6 more than the sum of ST-segment elevation in leads V1-3 identified takotsubo cardiomyopathy with a high sensitivity and specificity. 14 Kosuge et al recently reported that the combination of ST-segment depression in lead aVR and no STsegment elevation in lead V1, or the combination of positive T wave in lead aVR and no negative T wave in lead aVR, was more useful in identifying takotsubo cardiomyopathy. 15,16 EchocardiographyEchocardiography plays a central role in the diagnosis of takotsubo cardiomyopathy. Typically, RWMA is found in the apical to mid segments of the left ventricle, extending beyond a single coronary territory. Relative compensatory hypercontractility is often found in the basal segment. Other patterns akotsubo cardiomyopathy is an acute cardiac syndrome mimicking acute myocardial infarction (AMI), and is characterized by chest symptoms, electrocardiographic (ECG) changes and reversible regional wall motion abnormality (RWMA) in the apical to mid segments of the left ventricle. 1-5 In contrast to AMI, takotsubo cardiomyopathy exhibits RWMA independent of acute plaque rupture or myocardial ischemia with coronary atherosclerosis during the early stage. RWMA occurs in the apical to mid segments of the left ventricle, extending beyond a single coronary territory (Figure 1), and it usually resolves spontaneously within a matter of days to a few weeks.Takotsubo cardiomyopathy was first reported by Sato et al at Hiroshima City Hospital in 1990, 1-3 since when it has become increasingly recognized worldwide. Several mechanisms, including multivessel coronary artery spasm, coronary microvascular dysfunction or catecholami...

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“…However, patients with coronary artery disease can develop TTC. Kurisu and colleagues (38) reported 10% of patients in their series of takotsubo patients (total patients=97) had >75% coronary artery obstruction in a major coronary vessel, though coronary stenosis is uncommon in patients presenting with TTC (1), and absence of an acute coronary artery syndrome is a diagnostic criterion for diagnosis of TTC.…”

Section: Coronary Angiographymentioning

confidence: 99%