Coronary microvascular dysfunction in takotsubo syndrome assessed by angiography-derived index of microcirculatory resistance: a pressure-wire-free tool
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- dc.contributor.author Sans-Roselló, Jordi
- dc.contributor.author Fernández-Peregrina, Estefanía
- dc.contributor.author Duran-Cambra, Albert
- dc.contributor.author Carreras-Mora, José
- dc.contributor.author Sionis, Alessandro
- dc.contributor.author Álvarez-García, Jesus
- dc.contributor.author García-García, Hector M.
- dc.date.accessioned 2022-06-20T07:01:50Z
- dc.date.available 2022-06-20T07:01:50Z
- dc.date.issued 2021
- dc.description.abstract Background: Coronary microvascular dysfunction (CMD) has been proposed as a key mechanism in Takotsubo syndrome (TTS). The non-hyperaemic angiography-derived index of microcirculatory resistance (NH-IMRangio) has been validated as a pressure-wire-free tool for the assessment of coronary microvasculature. We aimed to study the presence of CMD in TTS patients and its association with levels of cardiac biomarkers and systolic dysfunction patterns. Methods: We recruited 181 consecutive patients admitted for TTS who underwent cardiac angiography at a tertiary center from January 2014 to January 2021. CMD was defined as an NH-IMRangio ≥ 25. Plasma levels of NT-proBNP, high-sensitive cardiac troponin T (hs-cTnT) and the left ventricular ejection fraction (LVEF) by echocardiography were measured at admission. Results: Mean age was 75.3 years, 83% were women and median LVEF was 45%. All patients presented CMD (NH-IMRangio ≥ 25) in at least one epicardial coronary artery. The left anterior descending artery (LAD) showed higher median NH-IMRangio values than left circumflex (LCx) and right coronary arteries (RCA) (44.6 vs. 31.3 vs. 36.1, respectively; p < 0.001). NH-IMRangio values differed among ventricular contractility patterns in the LAD and RCA (p = 0.0152 and 0.0189, respectively) with the highest values in the mid-ventricular + apical and mid-ventricular + basal patterns. NT-proBNP levels, but not high-sensitive cardiac troponin T (hs-cTnT), were correlated with both the degree and the extent of CMD in patients with TTS. Lower LVEF was also associated with higher NH-IMRangio values. Conclusions: CMD is highly prevalent in patients admitted for TTS and is associated with both a higher degree of systolic dysfunction and higher BNP levels, but not troponin.
- dc.format.mimetype application/pdf
- dc.identifier.citation Sans-Roselló J, Fernández-Peregrina E, Duran-Cambra A, Carreras-Mora J, Sionis A, Álvarez-García J, et al. Coronary microvascular dysfunction in takotsubo syndrome assessed by angiography-derived index of microcirculatory resistance: a pressure-wire-free tool. J Clin Med. 2021 Sep 23; 10(19): 4331. DOI: 10.3390/jcm10194331
- dc.identifier.doi http://dx.doi.org/10.3390/jcm10194331
- dc.identifier.issn 2077-0383
- dc.identifier.uri http://hdl.handle.net/10230/53530
- dc.language.iso eng
- dc.publisher MDPI
- dc.rights Copyright © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (http://creativecommons.org/licenses/by/4.0/).
- dc.rights.accessRights info:eu-repo/semantics/openAccess
- dc.rights.uri http://creativecommons.org/licenses/by/4.0/
- dc.subject.keyword Angiography-derived index of microcirculatory resistance
- dc.subject.keyword Cardiac biomarkers
- dc.subject.keyword Coronary microvascular dysfunction
- dc.subject.keyword Left ventricular ejection fraction
- dc.subject.keyword Takotsubo syndrome
- dc.title Coronary microvascular dysfunction in takotsubo syndrome assessed by angiography-derived index of microcirculatory resistance: a pressure-wire-free tool
- dc.type info:eu-repo/semantics/article
- dc.type.version info:eu-repo/semantics/publishedVersion