Document Detail

Possible participation of endothelial cell apoptosis of coronary microvessels in the genesis of Takotsubo cardiomyopathy.
MedLine Citation:
PMID:  20556810     Owner:  NLM     Status:  MEDLINE    
BACKGROUND: Takotsubo cardiomyopathy (TCM) is characterized by systolic ballooning of the left ventricular apex. It is triggered by emotional or physical stress, but the exact mechanism through which stress leads to TCM is not known. HYPOTHESIS: Coronary microvessel apoptosis is the missing link between stress and TCM. METHODS: In 8 female patients with TCM, plasma catecholamines, Thrombolysis in Myocardial Infarction (TIMI) coronary flow grade and myocardial perfusion grade, and apoptosis of the coronary microvessels in the biopsied myocardial specimen by terminal deoxynucleotidyl transferase-mediated nick end-labeling (TUNEL) were examined. RESULTS: Plasma epinephrine and norepinephrine were increased to 663 +/- 445 and 875 +/- 812 pg/mL (mean +/- SD), respectively. Acetylcholine-induced delayed myocardial perfusion through the ballooning apical segment without flow disturbance in the epicardial coronary arteries (indicating microvessel spasm) and focal myocardial necrosis were observed in all subjects. Apical ballooning disappeared and myocardial perfusion delay was not inducible 1 month later. The number of vessels having apoptotic endothelial cells/10 vessels in arterioles, venules, and capillaries at initial biopsy and repeat biopsy 1 month later were 8.3 +/- 1.4 vs 0.4 +/- 1.1, P < 0.0001; 6.8 +/- 1.8 vs 0.3 +/- 0.7, P < 0.0001; and 7.9 +/- 1.0 vs 0.5 +/- 0.9, P < 0.0001, respectively. CONCLUSIONS: Left ventricular apical ballooning in TCM was considered to be caused by coronary microvessel spasm due to catecholamine-induced endothelial cell apoptosis and myocardial stunning after release of microvessel spasm. Endothelial cell apoptosis of coronary microvessel is therefore considered to be the missing link between stress and TCM.
Yasumi Uchida; Haruko Egami; Yasuto Uchida; Takeshi Sakurai; Masahito Kanai; Seiichiro Shirai; Osamu Nakagawa; Tomomitsu Oshima
Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Clinical cardiology     Volume:  33     ISSN:  1932-8737     ISO Abbreviation:  Clin Cardiol     Publication Date:  2010 Jun 
Date Detail:
Created Date:  2010-06-21     Completed Date:  2010-10-04     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  7903272     Medline TA:  Clin Cardiol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  371-7     Citation Subset:  IM    
Japan Foundation for Cardiovascular Research, Funabashi, Japan.
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MeSH Terms
Biological Markers / blood
Coronary Angiography
Coronary Circulation
Coronary Vasospasm / blood,  pathology*,  physiopathology
Coronary Vessels / metabolism,  pathology*,  physiopathology
Endothelial Cells / metabolism,  pathology*
Epinephrine / blood
In Situ Nick-End Labeling
Microvessels / metabolism,  pathology*,  physiopathology
Middle Aged
Norepinephrine / blood
Takotsubo Cardiomyopathy / blood,  pathology*,  physiopathology
Reg. No./Substance:
0/Biological Markers; 51-41-2/Norepinephrine; 51-43-4/Epinephrine

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