Optical Coherence Tomography Findings in Tako-Tsubo Cardiomyopathy

T ako-Tsubo (TT) cardiomyopathy is a rare clinical entity, initially described in Japan, characterized by a transient apical dyskinesia of unknown origin.1,2 Patients present with signs and symptoms typical of myocardial infarction, but the epicardial coronary arteries are normal and left ventricular wall motion abnormalities spontaneously resolve during follow-up.1-2 Although different etiologies have been proposed to explain the pathophysiology of TT, its cause remains unknown.Here we describe optical coherence tomography findings of a patient presenting with TT.A 63-year-old woman with a history of hypertension was admitted for prolonged chest pain.An ECG showed widespread 1-to 2-mm ST-segment elevation from V2 to V5.An echocardiogram revealed extensive anteroapical akinesia.Urgent coronary angiography using a left radial access revealed normal coronary arteries (completely smooth angiographic appearance) with normal antegrade coronary flow.Left ventricular angiography (Figure 1) disclosed a pattern characteristic of apical ballooning.The wall motion of the anterobasal and posterobasal left ventricular segments was hyperdynamic and left ventricular ejection fraction was 30%.Left ventricular end-diastolic pressure was 25 mm Hg, mitral regurgitation was absent, and no intraventricular gradient could be detected.Frequency domain optical coherence tomography (Dragon Fly, C7-XR, LightLab Imaging, St. Jude Medical, St. Louis, MO) with a nonocclusive technique was used to interrogate both the left anterior and left circumflex coronary arteries.Special care was taken to obtain