Time-Related Microcirculatory Dysfunction in Patients With Takotsubo Cardiomyopathy

MedicalResearch.com Interview with:
Dr. Fernando Alfonso
Cardiac Department
H.U de la Princesa
Madrid. Spain

MedicalResearch.com: What is the background for this study? What are the main findings?

Response: Tako-Tsubo Cardiomyopathy is, unfortunately, a “black hole” in current cardiology knowledge. We have a large background about its epidemiology and clinical course but, conversely, cardiology research have failed to decipher the involved mechanisms involved in its pathophysiology. Some of the initial proposed hypothesis like the ‘aborted myocardial infarction,’ with plaque rupture and thrombus formation, which subsequently dissipates leaving an unobstructed coronary artery have been rejected. At the present, the hypothesis of a large sympathetic activation appears central to the pathophysiology of Takotsubo cardiomyopathy. What is less known is the mechanism by which cathecolamines act to produce a transient regional myocardial stunning.

Previous findings suggest acute microvascular impairment at the time of clinical presentation. In our study we sought to assess the presence of microcirculatory dysfunction by invasively measuring the index of microvascular resistance (IMR) in a prospective cohort of patients presenting with Tako-Tsubo myocardiopaty.

We confirm that all Tako-Tsubo patients had a microvascular impairment during the acute phase and, importantly, we found a time-related trend in microvascular dysfunction recovery.

MedicalResearch.com: What should readers take away from your report?

Response: Microvascular dysfunction is present at acute phase of Tako-Tsubo myocardiopaty. Moreover, while myocardial stunning is recovering, microvascular impairment seems to follow the same trend to normalization.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Response: Our study, with a small cohort of patients, is just a hypothesis-generating work. We need to know if microvascular dysfunction plays a major role or is just an epiphenomenon due to other conditions like myocardial edema. A large series adding serial MR information could clarify this important question.

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Rivero F, Cuesta J, García-Guimaraes M, Bastante T, Alvarado T, Antuña P, Alfonso F. Time-Related Microcirculatory Dysfunction in Patients With Takotsubo Cardiomyopathy. JAMA Cardiol. Published online March 08, 2017. doi:10.1001/jamacardio.2016.5993

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Last Updated on March 9, 2017 by Marie Benz MD FAAD