Reversible coronary microvascular dysfunction: a common pathogenetic mechanism in Apical Ballooning or Tako-Tsubo Syndrome.
OBJECTIVE
To study coronary microvascular dysfunction as possible pathogenetic mechanism in Apical Ballooning Syndrome (ABS).


RESULTS
Fifteen ABS patients (all women, 68 +/- 14 years) underwent myocardial contrast echocardiography at baseline during adenosine infusion (140 microg/kg/min) and at 1-month follow-up and compared with a group of anterior ST-elevation myocardial infarction (STEMI) patients with similar clinical characteristics. Myocardial perfusion was assessed by contrast score index (CSI) and endocardial length of contrast defect (contrast defect length, CDL), whereas myocardial dysfunction by wall motion score index (WMSI), endocardial length of contractile dysfunction (wall motion defect length, WMDL), and LV ejection fraction (LVEF). At baseline, no difference in myocardial perfusion and dysfunction were present between the two groups. During adenosine challenge, while no changes were observed in STEMI group, in ABS patients CSI, CDL, WMSI, and WMDL significantly decreased compared with baseline (P < 0.001 vs. baseline for all parameters) and LVEF significantly increased (P = 0.01 vs. baseline). At 1-month follow-up, myocardial perfusion and dysfunction completely recovered in ABS patients (P < 0.001 vs. baseline for all parameters), whereas no significant changes were observed in STEMI group.


CONCLUSIONS
Our data strongly suggest that in ABS, irrespectively of its underlying aetiology, acute and reversible coronary microvascular vasoconstriction could represent a common pathophysiological mechanism.
Galiuto
Leonarda
L
Institute of Cardiology, Catholic University of the Sacred Heart, Policlinico A. Gemelli, Largo A. Gemelli, 8, Rome 00168, Italy. lgaliuto@rm.unicatt.it
De Caterina
Alberto Ranieri
AR
Porfidia
Angelo
A
Paraggio
Lazzaro
L
Barchetta
Sabrina
S
Locorotondo
Gabriella
G
Rebuzzi
Antonio Giuseppe
AG
Crea
Filippo
F
D000368:Aged; D000369:Aged, 80 and over; D003326:Coronary Circulation / Q000502:physiology; D004452:Echocardiography / Q000379:methods; D005260:Female; D006801:Humans; D008833:Microcirculation / Q000502:physiology*; D008875:Middle Aged; D009200:Myocardial Contraction / Q000502:physiology; D009203:Myocardial Infarction / Q000000981:diagnostic imaging / Q000503:physiopathology*; D055414:Myocardial Perfusion Imaging; D013318:Stroke Volume / Q000502:physiology; D054549:Takotsubo Cardiomyopathy / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology*; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology