Coronary microvascular dysfunction in takotsubo syndrome assessed by angiography-derived index of microcirculatory resistance : A pressure-wire-free tool
Sans-Roselló, Jordi (Section of Interventional Cardiology. MedStar Washington Hospital Center)
Fernández-Peregrina, Estefanía (Section of Interventional Cardiology, MedStar Washington Hospital Center)
Durán-Cambra, Albert (Institut d'Investigació Biomèdica Sant Pau)
Carreras-Mora, Jose (Hospital del Mar (Barcelona, Catalunya))
Sionis, Alessandro (Institut d'Investigació Biomèdica Sant Pau)
Alvarez-Garcia, Jesus (Centro de Investigación Biomédica en Red en Enfermedades Cardiovasculares)
Garcia-Garcia, Héctor Manuel (Section of Interventional Cardiology. MedStar Washington Hospital Center)
Universitat Autònoma de Barcelona

Date:	2021
Abstract:	Background: Coronary microvascular dysfunction (CMD) has been proposed as a key mechanism in Takotsubo syndrome (TTS). The non-hyperaemic angiography-derived index of microcirculatory resistance (NH-IMRangio) has been validated as a pressure-wire-free tool for the assessment of coronary microvasculature. We aimed to study the presence of CMD in TTS patients and its association with levels of cardiac biomarkers and systolic dysfunction patterns. Methods: We recruited 181 consecutive patients admitted for TTS who underwent cardiac angiography at a tertiary center from January 2014 to January 2021. CMD was defined as an NH-IMRangio ≥ 25. Plasma levels of NT-proBNP, high-sensitive cardiac troponin T (hs-cTnT) and the left ventricular ejection fraction (LVEF) by echocardiography were measured at admission. Results: Mean age was 75. 3 years, 83% were women and median LVEF was 45%. All patients presented CMD (NH-IMRangio ≥ 25) in at least one epicardial coronary artery. The left anterior descending artery (LAD) showed higher median NH-IMRangio values than left circumflex (LCx) and right coronary arteries (RCA) (44. 6 vs. 31. 3 vs. 36. 1, respectively; p < 0. 001). NH-IMRangio values differed among ventricular contractility patterns in the LAD and RCA (p = 0. 0152 and 0. 0189, respectively) with the highest values in the midventricular + apical and mid-ventricular + basal patterns. NT-proBNP levels, but not high-sensitive cardiac troponin T (hs-cTnT), were correlated with both the degree and the extent of CMD in patients with TTS. Lower LVEF was also associated with higher NH-IMRangio values. Conclusions: CMD is highly prevalent in patients admitted for TTS and is associated with both a higher degree of systolic dysfunction and higher BNP levels, but not troponin.
Rights:	Aquest document està subjecte a una llicència d'ús Creative Commons. Es permet la reproducció total o parcial, la distribució, la comunicació pública de l'obra i la creació d'obres derivades, fins i tot amb finalitats comercials, sempre i quan es reconegui l'autoria de l'obra original.
Language:	Anglès
Document:	Article ; recerca ; Versió publicada
Subject:	Coronary microvascular dysfunction ; Takotsubo syndrome ; Angiography-derived index of microcirculatory resistance ; Left ventricular ejection fraction ; Cardiac biomarkers
Published in:	Journal of clinical medicine, Vol. 10 Núm. 19 (October 2021) , p. 4331, ISSN 2077-0383

DOI: 10.3390/jcm10194331
PMID: 34640350

13 p, 2.3 MB

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