Document Detail


Microvascular function in Takotsubo cardiomyopathy with contrast echocardiography: prospective evaluation and review of literature.
MedLine Citation:
PMID:  19766449     Owner:  NLM     Status:  MEDLINE    
Abstract/OtherAbstract:
BACKGROUND: Takotsubo cardiomyopathy (TC) mimics ST-elevation myocardial infarction without substantial angiographic stenosis. Coronary microvascular dysfunction has been proposed as a possible mechanism in TC. The aim of this study was to evaluate microvascular function in TC using real-time myocardial contrast echocardiography (MCE). METHODS: Real-time MCE was performed within 24 hours of coronary angiographic diagnosis of TC. Myocardial perfusion was evaluated through qualitative and quantitative myocardial contrast echocardiographic analyses comparing normal segments with segments with dysfunctional wall motion (WM). RESULTS: From January 2007 to January 2008, 11 patients received diagnoses of TC. Of these patients, 9 were prospectively enrolled (mean age, 70.9 +/- 17.5 years; 8 women). Qualitative and quantitative myocardial contrast echocardiographic analyses were feasible in 87% and 81% of segments. Overall, concordance between qualitative MCE and WM for normal versus abnormal analysis was observed in 71% of segments (kappa = 0.442, SE = 0.08). Significantly lower myocardial blood flow velocity (beta) and lower myocardial blood flow (Abeta) were detected in segments with dysfunctional WM compared with those with normal WM (beta = 0.55 +/- 0.39 vs 0.90 +/- 0.77, P = .009; Abeta = 5.31 +/- 3.92 vs 12.38 +/- 13.47, P = .002). In the discordant segments between qualitative MCE and WM, the quantitative perfusion parameters beta and Abeta were significantly lower in segments with dysfunctional WM compared with those with normal WM (beta = 0.22 +/- 0.20 vs 1.79 +/- 0.57, P = .01; Abeta = 1.90 +/- 1.1 vs 24.29 +/- 19.9, P = .02). Recovery of WM abnormalities was detected in all patients during follow-up echocardiography (mean, 60.3 +/- 66.0 days). No contrast-related side effects were reported. During mean follow-up of 5.9 +/- 4.6 months, there were no cardiac events, but 1 noncardiac death (from lung cancer) occurred. CONCLUSION: TC is associated with abnormal myocardial perfusion detected with qualitative and quantitative MCE, indicative of microvascular dysfunction.
Authors:
Sahar S Abdelmoneim; Sunil V Mankad; Mathieu Bernier; Abhijeet Dhoble; Mary E Hagen; Sue Ann C Ness; Krishnaswamy Chandrasekaran; Patricia A Pellikka; Jae K Oh; Sharon L Mulvagh
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Publication Detail:
Type:  Journal Article; Review     Date:  2009-09-18
Journal Detail:
Title:  Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography     Volume:  22     ISSN:  1097-6795     ISO Abbreviation:  J Am Soc Echocardiogr     Publication Date:  2009 Nov 
Date Detail:
Created Date:  2009-11-03     Completed Date:  2010-01-07     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8801388     Medline TA:  J Am Soc Echocardiogr     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1249-55     Citation Subset:  IM    
Affiliation:
Division of Cardiovascular Diseases, Mayo Clinic, Rochester, Minnesota 55905, USA.
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MeSH Terms
Descriptor/Qualifier:
Aged
Aged, 80 and over
Blood Flow Velocity
Chi-Square Distribution
Contrast Media / administration & dosage*
Coronary Angiography
Echocardiography / methods*
Female
Fluorocarbons / administration & dosage*
Humans
Male
Microcirculation / physiology
Prospective Studies
Takotsubo Cardiomyopathy / physiopathology,  ultrasonography*
Chemical
Reg. No./Substance:
0/Contrast Media; 0/Definity; 0/Fluorocarbons

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