Transient impairment of coronary flow reserve in tako-tsubo cardiomyopathy is related to left ventricular systolic parameters

Abstract

Aims: Recent studies suggest that coronary flow reserve (CFR) is transiently impaired in tako-tsubo cardiomyopathy (TTC). Mechanisms by which such impairment occurs are still unknown. To assess the relationship between CFR obtained by transthoracic Doppler echocardiography (TDE) and parameters of left ventricular (LV) performance in patients with TTC.

Methods and results: A total of 20 consecutive patients in sinus rhythm, with TTC (mean age 70+/-9 years, 19 women) underwent serial evaluation of TDE-CFR, in the distal part of the left anterior descending coronary artery (LAD), at the acute phase and after recovery using intravenous adenosine infusion (140 microg/kg/min over 2 min). CFR was calculated as hyperaemic to basal mean diastolic coronary flow velocity (CFV). Average of the septal and lateral mitral annulus early diastolic (Ea) and systolic (Sa) tissue velocity, early (E) and late (A) diastolic transmitral velocity, the ratio E/Ea, wall motion score (WMS, 16 segment model), LV end-systolic volume index (ESV/m(2)) and LV end-diastolic volume index (EDV/m(2), biplane-Simpson method) were serially measured by TDE. Basal CFV, LV mass index and haemodynamics parameters did not differ between acute phase and recovery, whereas hyperaemic CFV increased significantly after recovery (P<0.01) leading to a greater CFR (2.9+/-0.3 vs. 2.1+/-0.4, P<0.0001). At the acute phase, hyperaemic CFV was significantly correlated to WMS, ESV/m(2), but not to E/Ea, whereas at recovery, hyperaemic CFV was not correlated to LV parameters. The improvement of CFR was closely correlated to the decrease of ESV/m(2), of WMS, but not to diastolic parameters. No significant correlation was found between CFR and E/Ea or LV mass index at each stage.

Conclusion: There is a transient impairment of CFR at the acute phase of TTC, which is due to a reduced vasodilating capacity. This impairment is closely correlated to LV systolic parameters. Diastolic compressive forces to the coronary microcirculation do not appear to play a critical role.