Assessment of coronary microcirculation in patients with takotsubo-like left ventricular dysfunction.

BACKGROUND The precise mechanism of takotsubo-like left ventricular (LV) dysfunction remains unclear. METHODS AND RESULTS Eight consecutive patients with takotsubo-like LV dysfunction were studied. In the acute phase and 3 weeks later, the coronary flow velocity spectrum and coronary flow velocity reserve (CFVR) were recorded by Doppler guidewire. The deceleration time of diastolic velocity (DDT; ms) was measured from the peak diastolic velocity to the point where the extrapolated line intersected the baseline. In all cases, CFVR of the 3 coronary arteries increased during follow-up (1.7+/-0.5 to 2.4+/-0.5 for the left anterior descending artery (p < 0.05), 1.7+/-0.5 to 2.7+/-0.8 for the left circumflex artery (p < 0.05) and 1.7+/-0.3 to 2.5+/-0.4 for the right coronary artery (p < 0.05)). In addition, the DDT of all coronary arteries increased during follow-up. CONCLUSIONS Decreased CFVR and short DDT were demonstrated in patients with takotsubo-like transient LV dysfunction in the acute phase, and these findings improved 3 weeks later, which suggests that coronary microvascular dysfunction may be a causative mechanism.

[1]  S. Kurisu.  Takotsubo-like left ventricular dysfunction , 2005 .

[2]  H. Matsubara,et al.  Ampulla (`Takotsubo') Cardiomyopathy of Both Ventricles , 2004 .

[3]  Y. Nishida,et al.  Assessing myocardial perfusion with the transthoracic Doppler technique in patients with reperfused anterior myocardial infarction: comparison with angiographic, enzymatic and electrocardiographic indices. , 2004, European heart journal.

[4]  Y. Neishi,et al.  [Relationship between coronary flow reserve and recovery of regional left ventricular function in patients with tako-tsubo-like transient left ventricular dysfunction]. , 2004, Journal of cardiology.

[5]  K. Nishioka,et al.  Myocardial perfusion and fatty acid metabolism in patients with tako-tsubo-like left ventricular dysfunction. , 2003, Journal of the American College of Cardiology.

[6]  M. Kondo,et al.  Assessment of clinical features in transient left ventricular apical ballooning. , 2003, Journal of the American College of Cardiology.

[7]  T. Nakata,et al.  Effect of intravenous propranolol on left ventricular apical ballooning without coronary artery stenosis (ampulla cardiomyopathy): three cases. , 2002, Circulation journal : official journal of the Japanese Circulation Society.

[8]  Y. Tsuruo,et al.  Emotional stress induces transient left ventricular hypocontraction in the rat via activation of cardiac adrenoceptors: a possible animal model of 'tako-tsubo' cardiomyopathy. , 2002, Circulation journal : official journal of the Japanese Circulation Society.

[9]  K. Nishioka,et al.  Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction. , 2002, American heart journal.

[10]  H. Sugihara,et al.  Assessment of ampulla (Takotsubo) cardiomyopathy with coronary angiography, two-dimensional echocardiography and99mTc-tetrofosmin myocardial single photon emission computed tomography , 2001, Annals of nuclear medicine.

[11]  H. Ogawa,et al.  Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris-Myocardial Infarction Investigations in Japan. , 2001, Journal of the American College of Cardiology.

[12]  T. Tamura,et al.  Ampulla cardiomyopathy ('Takotusbo' cardiomyopathy)--reversible left ventricular dysfunction: with ST segment elevation. , 2000, Japanese circulation journal.

[13]  T. Kawamoto,et al.  Can Coronary Blood Flow Velocity Pattern After Primary Percutaneous Transluminal Coronary Angiography Predict Recovery of Regional Left Ventricular Function in Patients With Acute Myocardial Infarction , 1999 .

[14]  R. Erbel,et al.  Current concepts of coronary flow reserve for clinical decision making during cardiac catheterization. , 1998, American heart journal.

[15]  M. Kern,et al.  From research to clinical practice: current role of intracoronary physiologically based decision making in the cardiac catheterization laboratory. , 1997, Journal of the American College of Cardiology.

[16]  Y. Taniyama,et al.  Alternation in the coronary blood flow velocity pattern in patients with no reflow and reperfused acute myocardial infarction. , 1996, Circulation.

[17]  A. Takeshita,et al.  Evidence of impaired endothelium-dependent coronary vasodilatation in patients with angina pectoris and normal coronary angiograms. , 1993, The New England journal of medicine.

[18]  H. M. Payne,et al.  Validation of A Doppler Guide Wire for Intravascular Measurement of Coronary Artery Flow Velocity , 1992, Circulation.

[19]  R. Wilson,et al.  Interstudy variability of coronary flow reserve. Influence of heart rate, arterial pressure, and ventricular preload. , 1990, Circulation.

[20]  J. Saffitz,et al.  Quantitative autoradiographic delineation of the distribution of beta-adrenergic receptors in canine and feline left ventricular myocardium. , 1987, Circulation research.

[21]  H W Woo,et al.  Advantages and applications of the centerline method for characterizing regional ventricular function. , 1986, Circulation.

[22]  L. Smith,et al.  Effect of Filming Projection and Interobserver Variability on Angiographic Biplane Left Ventricular Volume Determination , 1979, Circulation.

[23]  H. Ogawa,et al.  Transient left ventricular apical ballooning without coronary artery stenosis: a novel heart syndrome mimicking acute myocardial infarction. Angina Pectoris-Myocardial Infarction Investigations in Japan. , 2001, Journal of the American College of Cardiology.

[24]  H. Sato.  Tako-tsubo-like left ventricular dysfunction due to multivessel coronary spasm , 1990 .