title: Tortuosity, Recurrent Segments, and Bridging of the Epicardial Coronary Arteries in Patients With the Takotsubo Syndrome.
abstract: Myocardial bridging (MB) and a long recurrent wraparound left anterior descending artery (wrap-LAD) are coronary anatomic variants that have been recently suggested to be associated with takotsubo syndrome (TS). Until now, coronary artery tortuosity (CAT) has never been investigated in this setting. Our study sought to evaluate the prevalence of the aforementioned anatomic variants in a large population with TS. In this retrospective angiographic study, 109 patients with TS were compared with 109 age- and gender-matched subjects without coronary artery disease, valve heart disease, or cardiomyopathy. CAT was identified by ≥3 consecutive curvatures ≥90° (criteria 1) or by ≥2 consecutive curvatures ≥180° (criteria 2). Wrap-LAD was defined if any part of the vessel outreached the apex of the left ventricle and MB as the presence of a milking effect or a step-up and step-down phenomenon. An anatomic variant was found in 79 patients with TS (72%) and in 48 controls (44%) (p <0.001). CAT in at least 1 vessel (criteria 1: 49% vs 20%, p <0.001; criteria 2: 38% vs 13%, p <0.001), ≥2 vessels (criteria 2: 14% vs 3%, p = 0.005), and wrap-LAD (41% vs 27%, p = 0.02) were significantly more frequent in patients with TS than in controls. The prevalence of MB (9% vs 5%, p = 0.18) did not differ between groups. In conclusion, CAT and wrap-LAD have higher prevalence in patients with TS than in matched controls. These findings could support the hypothesis that anatomic variants might act as potential pathogenic substrates in TS.
authors.affiliation: Cardiology Department, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Arcari
authors.affiliation: Cardiology Department, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
authors.forename: Luca Rosario
authors.initials: LR
authors.lastname: Limite
authors.affiliation: Institute of Cardiology, Madre Giuseppina Vannini Hospital, Rome, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Cacciotti
authors.affiliation: Cardiology Department, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
authors.forename: Alessandro
authors.initials: A
authors.lastname: Alonzo
authors.affiliation: Cardiology Department, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
authors.forename: Maria Beatrice
authors.initials: MB
authors.lastname: Musumeci
authors.affiliation: Institute of Cardiology, Madre Giuseppina Vannini Hospital, Rome, Italy.
authors.forename: Ilaria
authors.initials: I
authors.lastname: Passaseo
authors.affiliation: San Raffaele, Rome, Italy.
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Marazzi
authors.affiliation: Cardiology Department, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
authors.forename: Andrea
authors.initials: A
authors.lastname: Berni
authors.affiliation: Institute of Cardiology, Madre Giuseppina Vannini Hospital, Rome, Italy.
authors.forename: Gerardo
authors.initials: G
authors.lastname: Ansalone
authors.affiliation: Cardiology Department, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy; IRCCS Neuromed, Pozzilli, IS, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Volpe
authors.affiliation: Cardiology Department, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy. Electronic address: camillo.autore@uniroma1.it.
authors.forename: Camillo
authors.initials: C
authors.lastname: Autore
mesh_terms: D000368:Aged; D017023:Coronary Angiography; D003324:Coronary Artery Disease / Q000000981:diagnostic imaging / Q000453:epidemiology*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D054084:Myocardial Bridging / Q000000981:diagnostic imaging / Q000453:epidemiology*; D015995:Prevalence; D012008:Recurrence; D012189:Retrospective Studies; D054549:Takotsubo Cardiomyopathy / Q000150:complications* / Q000000981:diagnostic imaging