Coronary microvascular dysfunction in Takotsubo syndrome and associations with left ventricular function
Abstract Aims Coronary microvascular dysfunction (CMD) has been proposed as an important pathophysiological mechanism in Takotsubo syndrome (TTS). Our aims were (i) to evaluate and compare levels of CMD in patients with TTS and patients with ischaemia and no obstructive coronary arteries (INOCA) and...
| Main Authors: | , , , , , , |
|---|---|
| Format: | Article |
| Language: | English |
| Published: |
Wiley
2023-08-01
|
| Series: | ESC Heart Failure |
| Subjects: | |
| Online Access: | https://doi.org/10.1002/ehf2.14394 |
| _version_ | 1797770781912989696 |
|---|---|
| author | Christina Ekenbäck Jannike Nickander Fadi Jokhaji Per Tornvall Henrik Engblom Jonas Spaak Jonas Persson |
| author_facet | Christina Ekenbäck Jannike Nickander Fadi Jokhaji Per Tornvall Henrik Engblom Jonas Spaak Jonas Persson |
| author_sort | Christina Ekenbäck |
| collection | DOAJ |
| description | Abstract Aims Coronary microvascular dysfunction (CMD) has been proposed as an important pathophysiological mechanism in Takotsubo syndrome (TTS). Our aims were (i) to evaluate and compare levels of CMD in patients with TTS and patients with ischaemia and no obstructive coronary arteries (INOCA) and (ii) to investigate associations between CMD and clinical parameters, left ventricular function, and coronary atherosclerosis in TTS. Methods and results We conducted a prospective study of 27 female TTS patients and an equally sized, age‐ and gender‐matched, cohort of INOCA patients. Coronary microvascular function was quantified invasively using the index of microcirculatory resistance (IMR), coronary flow reserve (CFR), and resistive reserve ratio (RRR). CMD was defined as IMR ≥ 25 and/or CFR ≤ 2. In the TTS patients, left ventricular function was assessed with echocardiography and cardiovascular magnetic resonance (CMR) imaging, and coronary atherosclerosis was visualized with intravascular ultrasound with near‐infrared spectroscopy (IVUS‐NIRS). The incidence of CMD was higher in the TTS patients than in the INOCA cohort (78% vs. 44%, P = 0.01), with higher IMR (30 vs. 14, P = 0.002), lower CFR (1.8 vs. 2.8, P = 0.009), and lower RRR (2.1 vs. 3.5, P = 0.003). In apical compared with midventricular TTS, IMR was numerically higher (50 vs. 28, P = 0.20), whereas CFR and RRR were lower (1.5 vs. 2.5, P = 0.003 and 1.6 vs. 2.7, P = 0.01, respectively). Global longitudinal strain and global circumferential strain, assessed with CMR imaging, were more impaired in apical than in midventricular TTS (−11 vs. −14, P < 0.001 and −12 vs. −15, P = 0.049, respectively). In the TTS patients, CFR and RRR correlated with echocardiography‐derived (R2 = 0.15, P = 0.002 and R2 = 0.18, P = 0.007, respectively) and CMR‐derived (R2 = 0.09, P = 0.025 and R2 = 0.10, P = 0.038, respectively) ejection fraction. CFR and RRR correlated inversely with CMR‐derived end‐diastolic volume index, end‐systolic volume index, and left ventricular mass index. IMR, CFR, and RRR were not associated with measures of coronary atherosclerosis derived by IVUS‐NIRS. Conclusions Coronary microvascular dysfunction is common in patients with TTS and more frequent than in patients with INOCA. CMD in TTS is more severe in the apical compared with the midventricular phenotype of the syndrome, is associated with left ventricular function, but is unrelated to coronary atherosclerosis. Our results support the notion of CMD as a key mediator in TTS. |
| first_indexed | 2024-03-12T21:27:07Z |
| format | Article |
| id | doaj.art-ed7ab645ae554fc99a1cb83b9867db1b |
| institution | Directory Open Access Journal |
| issn | 2055-5822 |
| language | English |
| last_indexed | 2024-03-12T21:27:07Z |
| publishDate | 2023-08-01 |
| publisher | Wiley |
| record_format | Article |
| series | ESC Heart Failure |
| spelling | doaj.art-ed7ab645ae554fc99a1cb83b9867db1b2023-07-28T06:30:48ZengWileyESC Heart Failure2055-58222023-08-011042395240510.1002/ehf2.14394Coronary microvascular dysfunction in Takotsubo syndrome and associations with left ventricular functionChristina Ekenbäck0Jannike Nickander1Fadi Jokhaji2Per Tornvall3Henrik Engblom4Jonas Spaak5Jonas Persson6Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital Division of Cardiovascular Medicine Stockholm SwedenDepartment of Clinical Physiology Karolinska Institutet and Karolinska University Hospital Stockholm SwedenDepartment of Cardiology and Physiology Danderyd Hospital Stockholm SwedenDepartment of Clinical Science and Education, Södersjukhuset Karolinska Institutet Stockholm SwedenDepartment of Clinical Physiology Karolinska Institutet and Karolinska University Hospital Stockholm SwedenKarolinska Institutet, Department of Clinical Sciences, Danderyd Hospital Division of Cardiovascular Medicine Stockholm SwedenKarolinska Institutet, Department of Clinical Sciences, Danderyd Hospital Division of Cardiovascular Medicine Stockholm SwedenAbstract Aims Coronary microvascular dysfunction (CMD) has been proposed as an important pathophysiological mechanism in Takotsubo syndrome (TTS). Our aims were (i) to evaluate and compare levels of CMD in patients with TTS and patients with ischaemia and no obstructive coronary arteries (INOCA) and (ii) to investigate associations between CMD and clinical parameters, left ventricular function, and coronary atherosclerosis in TTS. Methods and results We conducted a prospective study of 27 female TTS patients and an equally sized, age‐ and gender‐matched, cohort of INOCA patients. Coronary microvascular function was quantified invasively using the index of microcirculatory resistance (IMR), coronary flow reserve (CFR), and resistive reserve ratio (RRR). CMD was defined as IMR ≥ 25 and/or CFR ≤ 2. In the TTS patients, left ventricular function was assessed with echocardiography and cardiovascular magnetic resonance (CMR) imaging, and coronary atherosclerosis was visualized with intravascular ultrasound with near‐infrared spectroscopy (IVUS‐NIRS). The incidence of CMD was higher in the TTS patients than in the INOCA cohort (78% vs. 44%, P = 0.01), with higher IMR (30 vs. 14, P = 0.002), lower CFR (1.8 vs. 2.8, P = 0.009), and lower RRR (2.1 vs. 3.5, P = 0.003). In apical compared with midventricular TTS, IMR was numerically higher (50 vs. 28, P = 0.20), whereas CFR and RRR were lower (1.5 vs. 2.5, P = 0.003 and 1.6 vs. 2.7, P = 0.01, respectively). Global longitudinal strain and global circumferential strain, assessed with CMR imaging, were more impaired in apical than in midventricular TTS (−11 vs. −14, P < 0.001 and −12 vs. −15, P = 0.049, respectively). In the TTS patients, CFR and RRR correlated with echocardiography‐derived (R2 = 0.15, P = 0.002 and R2 = 0.18, P = 0.007, respectively) and CMR‐derived (R2 = 0.09, P = 0.025 and R2 = 0.10, P = 0.038, respectively) ejection fraction. CFR and RRR correlated inversely with CMR‐derived end‐diastolic volume index, end‐systolic volume index, and left ventricular mass index. IMR, CFR, and RRR were not associated with measures of coronary atherosclerosis derived by IVUS‐NIRS. Conclusions Coronary microvascular dysfunction is common in patients with TTS and more frequent than in patients with INOCA. CMD in TTS is more severe in the apical compared with the midventricular phenotype of the syndrome, is associated with left ventricular function, but is unrelated to coronary atherosclerosis. Our results support the notion of CMD as a key mediator in TTS.https://doi.org/10.1002/ehf2.14394Takotsubo syndromeCoronary microvascular dysfunctionIndex of microcirculatory resistanceCoronary flow reserveIschaemia and no obstructive coronary arteriesCardiovascular magnetic resonance imaging |
| spellingShingle | Christina Ekenbäck Jannike Nickander Fadi Jokhaji Per Tornvall Henrik Engblom Jonas Spaak Jonas Persson Coronary microvascular dysfunction in Takotsubo syndrome and associations with left ventricular function ESC Heart Failure Takotsubo syndrome Coronary microvascular dysfunction Index of microcirculatory resistance Coronary flow reserve Ischaemia and no obstructive coronary arteries Cardiovascular magnetic resonance imaging |
| title | Coronary microvascular dysfunction in Takotsubo syndrome and associations with left ventricular function |
| title_full | Coronary microvascular dysfunction in Takotsubo syndrome and associations with left ventricular function |
| title_fullStr | Coronary microvascular dysfunction in Takotsubo syndrome and associations with left ventricular function |
| title_full_unstemmed | Coronary microvascular dysfunction in Takotsubo syndrome and associations with left ventricular function |
| title_short | Coronary microvascular dysfunction in Takotsubo syndrome and associations with left ventricular function |
| title_sort | coronary microvascular dysfunction in takotsubo syndrome and associations with left ventricular function |
| topic | Takotsubo syndrome Coronary microvascular dysfunction Index of microcirculatory resistance Coronary flow reserve Ischaemia and no obstructive coronary arteries Cardiovascular magnetic resonance imaging |
| url | https://doi.org/10.1002/ehf2.14394 |
| work_keys_str_mv | AT christinaekenback coronarymicrovasculardysfunctionintakotsubosyndromeandassociationswithleftventricularfunction AT jannikenickander coronarymicrovasculardysfunctionintakotsubosyndromeandassociationswithleftventricularfunction AT fadijokhaji coronarymicrovasculardysfunctionintakotsubosyndromeandassociationswithleftventricularfunction AT pertornvall coronarymicrovasculardysfunctionintakotsubosyndromeandassociationswithleftventricularfunction AT henrikengblom coronarymicrovasculardysfunctionintakotsubosyndromeandassociationswithleftventricularfunction AT jonasspaak coronarymicrovasculardysfunctionintakotsubosyndromeandassociationswithleftventricularfunction AT jonaspersson coronarymicrovasculardysfunctionintakotsubosyndromeandassociationswithleftventricularfunction |