Abstract 4838: Diffuse, Marked, Reversible Impairment in Coronary Microcirculation in Stress Cardiomyopathy: A Vasodilator Stress Echo Study
Stress cardiomyopathy, also referred to as Takotsubo cardiomyopathy (TC) has been linked to excessive sympathetic stimulation, which can be toxic for myocytes and coronary microcirculation. Aim: To assess coronary flow reserve (CFR) in TC. Methods: 30 consecutive patients (5 males; 68±12 years) meeting diagnostic criteria for TC were evaluated with transthoracic dipyridamole (0.84 mg/kg over 6′) stress echo and Pulsed Doppler CFR assessment on mid-distal left anterior descending (LAD) and posterior descending of right coronary artery (PD). Wall Motion Score Index (WMSI) was evaluated at baseline and during stress. All patients were followed-up clinically and - on day 1, day 7 (±2 days) and at 6 months - by repeat stress echo. Twenty-one age and gender matched controls were also studied. Results: CFR was obtained in all patients on LAD and in 25 on PD. All pts showed a transient apical ballooning in the acute phase (day 1 of admission), with progression recovery of function at follow-up (WMSI, day 1=1.7±.2; day 7=1.4±.14; 6-months=1.0±0.1; p<0.001 vs day 1 and vs. day 7). When compared to controls, CFR was reduced on day 1 (upon admission) and it showed early recovery in the subacute (pre-discharge) assessment on day 7. CFR values remained stable at 6-months follow-up (see figure⇓). Conclusion: TC is characterized by a profound, diffuse, coronary microcirculatory disturbance in the acute phase, with early reversal to near-normal values within a few days, paralleling the functional recovery in regional wall motion. The reversible coronary microcirculatory abnormality can be observed also in the territory of right coronary artery.