Angiographic assessment of myocardial perfusion in Tako-Tsubo syndrome.
OBJECTIVE
To angiographically assess myocardial perfusion in patients with Tako-Tsubo syndrome (TTS) in comparison with control individuals and patients with ST-elevation myocardial infarction (STEMI).


BACKGROUND
Coronary microvascular dysfunction has been proposed as the pathophysiological mechanism underlying TTS.


METHODS
We retrospectively selected consecutive TTS patients showing typical left ventricular (LV) apical dysfunction admitted to our Department in the period 2007-2011 (n=25). We also enrolled an age and gender-matched control group showing normal coronary arteries (CTR, n=25), patients with STEMI undergoing primary percutaneous intervention with myocardial reperfusion (SR, n=25) or microvascular obstruction (SMVO, n=25). TIMI flow, TIMI frame count (TFC) and both qualitative and quantitative myocardial blush grade in LV apex were assessed. Specifically, myocardial perfusion was quantitatively evaluated using 'Quantitative Blush Evaluator' (QuBE), an open source software previously validated in the setting of STEMI.


RESULTS
In TTS, TIMI flow on the LAD was significantly lower and TFC significantly higher compared to CTR and SR (p=0.008 for both), while it did not significantly differ compared to SMVO (p=0.06). In TTS, MBG was significantly lower than that in CTR and SR (p=0.001 for both), while it was significantly higher than that in SMVO (p<0.001). In TTS, QuBE score was significantly lower than that in CTR and SR (p=0.001 for both) and higher than in SMVO (p=0.02).


CONCLUSIONS
Our data indicate that myocardial perfusion assessed during angiography is more impaired in patients with TTS than in patients with STEMI exhibiting myocardial reperfusion, while it is less impaired than in patients with STEMI exhibiting MVO.
Institute of Cardiology, Catholic University of the Sacred Heart, Rome, Italy. Electronic address: adecatro@yahoo.it.
Alberto R
AR
De Caterina
Antonio Maria
AM
Leone
Leonarda
L
Galiuto
Eloisa
E
Basile
Elisa
E
Fedele
Lazzaro
L
Paraggio
Giovanni Luigi
GL
De Maria
Italo
I
Porto
Giampaolo
G
Niccoli
Francesco
F
Burzotta
Carlo
C
Trani
Antonio G
AG
Rebuzzi
Filippo
F
Crea
D000368:Aged; D017023:Coronary Angiography / Q000379:methods*; D003326:Coronary Circulation / Q000502:physiology*; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008833:Microcirculation; D011237:Predictive Value of Tests; D015203:Reproducibility of Results; D012189:Retrospective Studies; D012720:Severity of Illness Index; D054549:Takotsubo Cardiomyopathy / Q000000981:diagnostic imaging* / Q000503:physiopathology
Microvascular dysfunction; Myocardial blush grade; QuBE; Tako-Tsubo syndrome