Microcirculatory dysfunction and autonomic disturbance in Takotsubo syndrome

Abstract

We thank Drs Khalid and Chhabra for their Correspondence (Takotsubo cardiomyopathy and microcirculatory dysfunction. Nat. Rev. Cardiol. doi:10.1038/nrcardio.2015.88)1 on our Review (Epidemiology and pathophysiology of Takotsubo syndrome. Nat. Rev. Cardiol. doi:10.1038/nrcardio.2015.39),2 and their contribution to the field. They and others provide clear evidence that, during the acute phase of Takotsubo syndrome and in some patients at follow-up, abnormalities of coronary flow exist when measured indirectly using noninvasive techniques, and indirectly via the Thrombolysis In Myocardial Infarction (TIMI) frame count. Three important issues should be considered regarding the mechanism they raise in the context of the findings from their studies of TIMI frame count and also those of other studies of coronary flow reserve (CFR). Firstly, whether the abnormalities of coronary flow were present before the acute episode in susceptible individuals, or are sequelae to the acute catecholaminergic storm, is uncertain. Current evidence from Khalid and colleagues supports only the latter, raising the issue of whether the abnormalities detected are causative, secondary but pathophysiologically relevant modifying phenomena, or associated bystander phenomena. A preclinical study of myocardial perfusion before, during, and immediately after the induction of Takotsubo-like apical abnormalities using myocardial contrast echocardiography did not detect any abnormalities of coronary flow or myocardial ischaemia.3 Although this study has the limitations of being performed in a rat model and using a pharmacological trigger (isoproterenol) rather than endogenous stress, it supports the conclusion that acute catecholamine-induced apical dysfunction, resembling acute Takotsubo syndrome, can occur in the absence of myocardial ischaemia during the acute phase. Secondly, why such abnormalities of the microvascular circulation should affect REPLY

DOI: 10.1038/nrcardio.2015.90

Cite this paper

@article{Akashi2015MicrocirculatoryDA, title={Microcirculatory dysfunction and autonomic disturbance in Takotsubo syndrome}, author={Yoshihiro J Akashi and Alexander R. Lyon}, journal={Nature Reviews Cardiology}, year={2015}, volume={12}, pages={497-497} }