Thrombolysis In Myocardial Infarction Frame Count in Takotsubo Cardiomyopathy

Microvascular Dysfunction in Takotsubo Cardiomyopathy

“…Invasive studies (using TIMI frame counts, myocardial perfusion grading, intracoronary Doppler evaluation of vasomotor function, coronary flow reserve and thermodilution method to assess index of microvascular resistance) and noninvasive studies (using doppler echocardiography, myocardial contrast echocardiography, SPECT/PET metabolism/ perfusion and Cardiac MRI) have all demonstrated coronary microvascular dysfunction in the acute phase of takotsubo cardiomyopathy 5,7,[12][13][14][15][17][18][19][20][22][23][24][25][26][27][28]33 Of significance, all of these microvascular abnormalities demonstrated by both invasive and noninvasive testing usually are transient and reversible, with follow up testing indicating normalization of microvascular function, in parallel with recovery of LV function. The precise mechanism of this transient coronary microvascular dysfunction, although not completely understood, could involve adrenoreceptor overstimulation/sympathetic hyperactivity, resulting from a catecholamine surge secondary to physical or emotional stress and differences in the type and density of adrenoreceptors in the cardiac apex versus the base might partly explain the proclivity of transient apical dysfunction in TC.…”

“…The authors postulated that this could potentially explain the presence of left ventricular apical dysfunction with sparing of the basal segments, in patients with TC. 13 On the contrary, higher TFCs were noted in all three coronary artery territories in the acute phase of TC in a study by Bybee et al, which suggested diffuse coronary microcirculatory abnormalities. 12 In this study, the TFC from admission coronary angiograms of 16 female patients with TC were compared with the TFC of 16 age and gender matched control cohort who had normal coronary angiograms preceding valve surgery.…”

“…A retrospective study by Khalid et al, compared TFC in 16 patients with TC with 15 controls with normal coronary angiograms. 13 The mean corrected TFC in the LAD of TC patients was higher than those of the controls (19. 25 in right coronary artery, between TC cases and controls, respectively). The mean corrected TFC was higher (by 3 frames/sec) in the LAD of TC patients as compared to the control population, indicating presence of microvascular or endothelial abnormalities in the LAD territory.…”

Coronary slow flow in the setting of Tako-tsubo cardiomyopathy: A causative factor? An innocent bystander? Or a prognostic sign?

“…Therefore, beyond serving as a potential contributor to the pathogenesis, there might exist further implications of CSF phenomenon in the setting of TTC. Accordingly, we would like to draw particular attention to the prognostic relevance of this phenomenon in the setting of TTC, as mentioned in our previous report [5], on top of a variety of potential risk stratifies, and would like to have further information regarding a few specific points in the interesting study of Khalid N et al [4].…”

“…have been suggested regarding the pathophysiology of the disease, the exact mechanism has yet to be fully established [2]. In his/her recently published elegant article [3], Khalid N put a special emphasis on the microvascular dysfunction hypothesis regarding the pathogenesis of TTC based on their recently published study (by Khalid N et al) [4]. In this study, the authors successfully demonstrated the presence of microvascular dysfunction and coronary slow low (CSF) pattern in the territory of left anterior descending (LAD) artery (as demonstrated with higher mean level of TIMI frame counts (TFC)) in their TTC patients compared with control group [4].…”