Arcari Luca, Limite Luca Rosario, Cacciotti Luca, Alonzo Alessandro, Musumeci Maria Beatrice, Passaseo Ilaria, Marazzi Giuseppe, Berni Andrea, Ansalone Gerardo, Volpe Massimo, Autore Camillo
Cardiology Department, Clinical and Molecular Medicine Department, Faculty of Medicine and Psychology, Sapienza University of Rome, Rome, Italy.
Institute of Cardiology, Madre Giuseppina Vannini Hospital, Rome, Italy.
Am J Cardiol. 2017 Jan 15;119(2):243-248. doi: 10.1016/j.amjcard.2016.09.055. Epub 2016 Oct 8.
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.
心肌桥（MB）和长节段反复环绕的左前降支动脉（wrap-LAD）是冠状动脉解剖变异，最近有人提出它们与应激性心肌病（TS）有关。到目前为止，尚未在此背景下研究冠状动脉迂曲（CAT）。我们的研究旨在评估一大群TS患者中上述解剖变异的发生率。在这项回顾性血管造影研究中，将109例TS患者与109例年龄和性别匹配、无冠状动脉疾病、瓣膜性心脏病或心肌病的受试者进行了比较。CAT通过≥3个连续曲率≥90°（标准1）或≥2个连续曲率≥180°（标准2）来确定。如果血管的任何部分延伸到左心室心尖以外，则定义为wrap-LAD，而MB则根据是否存在挤奶效应或阶梯样升降现象来确定。在79例TS患者（72%）和48例对照者（44%）中发现了解剖变异（p<0.001）。至少1支血管存在CAT（标准1：49%对20%，p<0.001；标准2：38%对13%，p<0.001）、≥2支血管存在CAT（标准2：14%对3%，p = 0.005）以及wrap-LAD（41%对27%，p = 0.02）在TS患者中显著高于对照组。两组间MB的发生率（9%对5%，p = 0.18）无差异。总之，TS患者中CAT和wrap-LAD的发生率高于匹配的对照组。这些发现可能支持解剖变异可能是TS潜在致病基础的假说。
