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

Figures & data

Table

CFR	coronary flow reserve
ICU	intensive care unit
LAD	left anterior descending artery
LV	left ventricle
PD	right coronary artery
TC	tako-tsubo cardiomyopathy
WMSI	wall motion score index

Table I.  Rest and stress findings in the study population and in control group.

	Takotsubo Group	Control Group	Sig.
No. of patients	30	30
Age (years)	68±12	56±14	0,05
Sex (male/female)	5/25	8/22	ns
Smoking habit	10 (33%)	8 (27%)	na
Hypertension	9 (30%)	0	0,0010
Diabetes	2 (7%)	0	0,0010
Hyper cholesterolemia	14 (47%)	5 (16%)	0,05
Resting echocardiography
LV End-diastolic volume (ml)	126±20	99±17	0,05
LV End systolic volume (ml)	79±15	37±6	0,05
LV End-diastolic diameter (mm)	52±4	48±3	0,05
LV End-systolic diameter (mm)	36±10	28±3	0,05
Ejection Fraction (%)	37±5	62±3	0,05
Left Ventricular Mass Index (gm/m2)	110±15	98±12	0,05
Wall Motion Score Index at rest (day 1)	1.7±0.22	1
Stress echocardiography
Wall Motion Score Index at peak stress (day 1)	1.5±0.23	1	0,05
Coronary Flow Reserve on LAD (day 1)	1.8±0.24	3.2±0.3	0,05
Coronary Flow Reserve on PD (day 1)	1.9±0.21	3.2±0.3	0,05

LV: left ventricle, LAD: left anterior descending artery.

Table II.  Rest echo changes over time.

	Day 1	Discharge	6 months	Sig.
LV End-diastolic volume (ml)	126±20	126±13	123±21	0,03*
LV End systolic volume (ml)	79±15	65±10	55±10	0,001**
LV End-diastolic diameter (mm)	52±4	52±3	51±3	ns
LV End-systolic diameter (mm)	36±10	32±3	31±3	0,001**
Ejection Fraction (%)	37±5	48±5	54±4	0,001**
Wall Motion Score Index at rest	1.7±0.2	1.6±0.1	1.0±0.1	0,001**
Wall Motion Score Index at peak stress	1.5±0.2	1.2±0.2	1.0±0.1	0,001**
CFR on LAD	1.8±0.2	2.4±0.3	2.6±0.2	0,001**
CFR on RCA	1.9±0.2	2.4±0.3	2.6±0.2	0,001**

*Discharge vs. 6 months.

**All comparison significant in between groups.

LV: left ventricle, CFR: coronary flow reserve, LAD: left anterior descending artery.

Figure 1.  Transthoracic echocardiography: time course of left ventricular four-chamber view (top) and Doppler-derived coronary flow reserve (CFR) on left anterior descending coronary artery (middle) and on right coronary artery (bottom) at day 1 (acute phase), at discharge, and 6 months after discharge. Top: end-systolic frame showing a large akinetic apex at admission (rest WMSI) and improving at discharge (rest WMSI), with complete recovery of regional function after 6 months (rest WMSI). Middle panel: coronary flow velocity profile at base-line and after dipyridamole on LAD at each time point as for wall motion score index (WMSI). Bottom panel: coronary flow velocity profile at base-line and after dipyridamole on right coronary artery at each time point as for WMSI.

Figure 2.  Coronary flow reverse (CFR) in the left anterior descending artery (LAD) area (white boxes) and in the right coronary artery (RCA) area (black boxes) in control subjects, at admission (acute), at discharge (subacute), and at 6-month follow-up (values are expressed as means±SD).

Figure 3.  Correlation between CFR on LAD and rest WMSI at admission, at discharge, and at 6-month follow-up.

Figure 4.  Correlation between CFR on LAD and peak WMSI at admission, at discharge, and at 6-month follow-up.