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Clinical Research in Cardiology

Open Access 20-11-2023 | Angiography | Original Paper

Coronary microvascular dysfunction in Takotsubo syndrome: an analysis using angiography-derived index of microcirculatory resistance

Authors: Victor Schweiger, Thomas Gilhofer, Rick Fang, Alessandro Candreva, Burkhardt Seifert, Davide Di Vece, Michael Wuerdinger, Iva Koleva, Katja Rajman, Maciej Cieslik, Alexander Gotschy, Jonathan Michel, Julia Stehli, David Niederseer, Linn Ryberg, Jelena Ghadri, Frank Ruschitzka, Barbara Stähli, Victoria Lucia Cammann, Christian Templin

Published in: Clinical Research in Cardiology

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Abstract

Background

Coronary microvascular dysfunction (CMD) has been proposed as a crucial factor in the pathophysiology of Takotsubo syndrome (TTS). The angiography-derived index of microcirculatory resistance (caIMR) offers an alternative to conventional hyperemic wire-based IMR to assess CMD. We aimed to evaluate CMD’s prevalence, transience, and impact on in-hospital outcomes in TTS.

Methods

All three coronary arteries of 96 patients with TTS were assessed for their coronary angiography derived Index of microcirculatory Resistance (caIMR) and compared to non-obstructed vessels of matched patients with ST-elevation myocardial infarction. Further, the association between caIMR and the TTS-specific combined in-hospital endpoint of death, cardiac arrest, ventricular arrhythmogenic events and cardiogenic shock was investigated.

Results

Elevated IMR was present in all TTS patients, with significantly elevated caIMR values in all coronary arteries compared to controls. CaIMR did not differ between apical and midventricular TTS types. CaIMR normalized in TTS patients with follow-up angiographies performed at a median of 28 months (median caIMR at event vs follow-up: LAD 34.8 [29.9–41.1] vs 20.3 [16.0–25.3], p < 0.001; LCX: 38.7 [32.9–50.1] vs 23.7 [19.4–30.5], p < 0.001; RCA: 31.7 [25.0–39.1] vs 19.6 [17.1–24.0], p < 0.001). The extent of caIMR elevation significantly correlated with the combined in-hospital endpoint (p = 0.036).

Conclusion

TTS patients had evidence of elevated caIMR in at least one coronary artery with a trend towards higher LAD caIMR in apical type TTS and normalization after recovery. Furthermore, extent of caIMR elevation was associated with increased risk of in-hospital MACE of TTS patients.

Graphical abstract

Appendix
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Metadata
Title
Coronary microvascular dysfunction in Takotsubo syndrome: an analysis using angiography-derived index of microcirculatory resistance
Authors
Victor Schweiger
Thomas Gilhofer
Rick Fang
Alessandro Candreva
Burkhardt Seifert
Davide Di Vece
Michael Wuerdinger
Iva Koleva
Katja Rajman
Maciej Cieslik
Alexander Gotschy
Jonathan Michel
Julia Stehli
David Niederseer
Linn Ryberg
Jelena Ghadri
Frank Ruschitzka
Barbara Stähli
Victoria Lucia Cammann
Christian Templin
Publication date
20-11-2023
Publisher
Springer Berlin Heidelberg
Published in
Clinical Research in Cardiology
Print ISSN: 1861-0684
Electronic ISSN: 1861-0692
DOI
https://doi.org/10.1007/s00392-023-02329-7
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