Takotsubo cardiomyopathy is not due to plaque rupture: an intravascular ultrasound study.
BACKGROUND
Plaque rupture with subsequent transient thrombotic coronary occlusion by a fast-dissolving clot is one of the proposed pathogenic mechanisms in Takotsubo cardiomyopathy (TC).


OBJECTIVE
The aim of this study was to seek evidence for the hypothesis of transient coronary thrombosis as the underlying mechanism of TC by means of intravascular ultrasound (IVUS).


METHODS
In our database of 63 consecutive patients with TC we identified 10 patients (16%) who had undergone IVUS during their initial left heart catheterisation.


RESULTS
A median length of 67 mm of the left anterior descending artery was analyzed (interquartile range [IQR]: 63.3-70.1 mm). Median lumen diameter, median vessel diameter, median plaque and media volume were 2.9 mm (IQR: 2.7-3.1 mm), 4.2 mm (IQR: 3.8-4.4 mm), and 90.9 mm(3) (IQR: 70.4-101.4 mm(3)), respectively. Plaque rupture, positive remodeling, and presumed intracoronary thrombus were absent in all patients.


CONCLUSIONS
In conclusion, plaque rupture does not account for the regional wall motion abnormalities observed in TC. The previously reported observation of plaque rupture in TC seems to constitute an incidental finding. We suggest that the theory of aborted myocardial infarction as the underlying cause of TC should be abandoned once and for all.
First Department of Medicine, University Medical Centre and Faculty of Medicine Mannheim, University of Heidelberg, Mannheim, Germany. dariush.haghi@med.ma.uni-heidelberg.de
Dariusch
D
Haghi
Stefanie
S
Roehm
Karsten
K
Hamm
Niels
N
Harder
Tim
T
Suselbeck
Martin
M
Borggrefe
Theano
T
Papavassiliu
D000368:Aged; D000369:Aged, 80 and over; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000150:complications / Q000000981:diagnostic imaging*; D003328:Coronary Thrombosis / Q000000981:diagnostic imaging* / Q000209:etiology; D019317:Evidence-Based Medicine; D005260:Female; D006801:Humans; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D012422:Rupture, Spontaneous; D054549:Takotsubo Cardiomyopathy / Q000000981:diagnostic imaging* / Q000209:etiology; D018084:Ultrasonography, Interventional