Diffuse, marked, reversible impairment in coronary microcirculation in stress cardiomyopathy: a Doppler transthoracic echo study

Abstract

The aim of the study was to assess coronary flow reserve (CFR) in tako-tsubo cardiomyopathy (TC).

Methods and results: Thirty consecutive patients (5 males; age 68+/-12 years) meeting diagnostic criteria for TC were evaluated with transthoracic dipyridamole (0.84 mg/kg over 6 min) stress echo and pulsed Doppler CFR assessment on mid-distal left anterior descending (LAD) and posterior descending of right coronary artery (PD). Wall motion score index (WMSI) was evaluated at base-line and during stress. All patients were followed up clinically and-on day 1, day 7 (+/-2 days), and at 6 months-by repeat stress echo. Thirty gender- matched controls were also studied. CFR was obtained in all patients on LAD and in 25 on PD. All showed a transient apical ballooning in the acute phase (day 1 of admission), with progressive recovery of function at follow-up (WMSI, day 1 = 1.7+/-0.2; day 7 = 1.4+/-0.14; 6 months = 1.0+/-0.1; P<0.001 versus day 1 and versus day 7). When compared to controls (3.1+/-0.5), CFR on LAD was reduced on day 1 (1.8+/-0.24, P<0.001) (upon admission), and it showed early recovery in the subacute (pre-discharge) assessment on day 7. CFR values remained stable at 6-month follow-up (2.6+/-0.3).

Conclusion: TC is characterized by a profound, diffuse coronary microcirculatory disturbance in the acute phase, with early reversal to near-normal values within a few days, paralleling the functional recovery in regional wall motion.