1. Filippo Crea, and Giovanna Liuzzo JACC 2013;61:1-11
Functional Alterations of Coronary Microcirculation May Cause ACS in Patients Without Obstructive Coronary Atherosclerosis Reversible intense coronary microvascular dysfunction has been demonstrated in Takotsubo or apical ballooning syndrome. A series of patients with apical ballooning syndrome underwent myocardial contrast echocardiography at baseline (Bsl); during infusion of adenosine (Adn) (140 μg/kg/min), a potent coronary microvascular vasodilator; and at 1-month follow-up (FUP). During Adn challenge, all patients exhibited a significant improvement of myocardial perfusion and of left ventricular (LV) function, which further improved at 1-month follow-up. (A) A clear perfusion defect is present at baseline within LV apical myocardium (arrows). (B) A striking decrease in the extent of the perfusion defect is evident during Adn infusion. Values of contrast score index and of LV ejection fraction in individual patients are shown at Bsl, at peak of Adn infusion, and at 1-month FUP in C and D, respectively. #p < 0.05 and *p < versus baseline. ACS = acute coronary syndrome.
Filippo Crea, and Giovanna Liuzzo JACC 2013;61:1-11
American College of Cardiology Foundation