Departments of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel.
Departments of Cardiology, Tel Aviv Sourasky Medical Center, affiliated with Tel Aviv School of Medicine, Tel Aviv University, 6 Weizman Street, Tel Aviv, Israel.
Heart Lung. 2024 Nov-Dec;68:46-51. doi: 10.1016/j.hrtlng.2024.06.007. Epub 2024 Jun 22.
The pathophysiology of Takotsubo syndrome (TTS) remains incompletely understood. While coronary microvascular dysfunction (CMD) is a potential pathophysiologic mechanism, evidence is limited.
We sought to evaluate CMD in patients with TTS.
Consecutive patients diagnosed with TTS were included and underwent coronary angiography with invasive microvascular function evaluation, including fractional flow reserve, Coronary Flow Reserve (CFR), Index of Microcirculatory Resistance (IMR), and Resistive Reserve Ratio (RRR). Patients had an echocardiography evaluation during their index admission and at approximately 6 weeks.
Thirty patients were included (mean age 74 ±9, 90 % female). Twenty-five patients (83 %) had at least one abnormal coronary microvascular function parameter. Abnormal parameters included CFR<2.5 in 20 patients (67 %), IMR>25 in 18 patients (60 %), and RRR<3.5 in 25 (83 %). Longer time from symptoms to angiography correlated with a higher CFR (r = 0.51, P<0.01), and had an area under the receiver operating characteristic curve of 0.793 (95 % CI 0.60-0.98) for pathologic CFR. Patients with emotional trigger had a lower rate of pathologic IMR compared with non-emotional trigger (36 % vs 81 %, p = 0.01). Follow up echocardiography performed at a median of 1.5 months (IQR 1.15-6) showed an improvement in left ventricular ejection fraction for all patients (from mean of 40 % to 57 %).
CMD was present in most patients with TTS. The role of microvascular function in TTS may vary according to the clinical presentation and RRR may be more sensitive for the diagnosis of CMD in TTS.
心肌顿抑综合征（TTS）的病理生理学仍不完全清楚。虽然冠状动脉微血管功能障碍（CMD）是一种潜在的病理生理机制，但证据有限。
我们旨在评估 TTS 患者的 CMD。
连续纳入诊断为 TTS 的患者，并进行冠状动脉造影和有创微血管功能评估，包括血流储备分数（FFR）、冠状动脉血流储备（CFR）、微血管阻力指数（IMR）和阻力储备比（RRR）。患者在入院时和大约 6 周时进行超声心动图评估。
共纳入 30 例患者（平均年龄 74±9 岁，90%为女性）。25 例（83%）患者至少有一项异常的冠状动脉微血管功能参数。异常参数包括 20 例（67%）患者的 CFR<2.5、18 例（60%）患者的 IMR>25 和 25 例（83%）患者的 RRR<3.5。从症状到造影的时间与较高的 CFR 相关（r=0.51，P<0.01），并具有 0.793（95%CI 0.60-0.98）的病理 CFR 的接收者操作特征曲线下面积。与非情绪触发相比，情绪触发的患者病理性 IMR 发生率较低（36% vs. 81%，p=0.01）。中位数为 1.5 个月（IQR 1.15-6）的随访超声心动图显示所有患者的左心室射血分数均有所改善（从平均 40%增加至 57%）。
大多数 TTS 患者存在 CMD。微血管功能在 TTS 中的作用可能因临床表现而异，RRR 可能对 TTS 中 CMD 的诊断更敏感。
