Key result
Higher NH-IMRangio correlates with elevated NT-proBNP and lower LVEF in Takotsubo syndrome.
Why the study?
Coronary microvascular dysfunction has been proposed as a key mechanism in Takotsubo syndrome, but its presence and association with cardiac biomarkers and systolic dysfunction patterns using NH-IMRangio needed evaluation.
Does coronary microvascular dysfunction assessed by NH-IMRangio correlate with cardiac biomarkers and systolic dysfunction in patients with Takotsubo syndrome?
Cohort (n=181)
No
Does coronary microvascular dysfunction assessed by NH-IMRangio correlate with cardiac biomarkers and systolic dysfunction in patients with Takotsubo syndrome?
Angiography-derived evaluation without a pressure wire demonstrates a high prevalence of coronary microvascular dysfunction in Takotsubo syndrome, which correlates with greater systolic dysfunction and NT-proBNP release.
Universal CMD in Takotsubo syndrome correlates with NT-proBNP and LVEF; hypothesis-generating for NH-IMRangio in prognosis, needs prospective validation.
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.
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Sans‐Roselló et al. (2021) conducted a cohort in Takotsubo syndrome (n=181). Coronary microvascular dysfunction (NH-IMRangio assessment) was evaluated on Correlation of highest NH-IMRangio value with NT-proBNP at admission (Rho 0.4845, p=<0.001). All patients with Takotsubo syndrome exhibited coronary microvascular dysfunction, and higher NH-IMRangio values significantly correlated with elevated NT-proBNP (Rho 0.4845, p<0.001) and lower LVEF.
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