Open AccessPossible Participation of Endothelial Cell Apoptosis of Coronary Microvessels in the Genesis of Takotsubo Cardiomyopathy
Author(s) -
Uchida Yasumi,
Egami Haruko,
Uchida Yasuto,
Sakurai Takeshi,
Kanai Masahito,
Shirai Seiichiro,
Nakagawa Osamu,
Oshima Tomomitsu
Publication year - 2010
Publication title -
clinical cardiology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.263
H-Index - 72
eISSN - 1932-8737
pISSN - 0160-9289
DOI - 10.1002/clc.20777
Subject(s) - medicine , microvessel , cardiology , myocardial infarction , perfusion , coronary arteries , tunel assay , cardiomyopathy , coronary circulation , pathology , angiogenesis , artery , blood flow , heart failure , immunohistochemistry
Abstract Background Takotsubo cardiomyopathy (TCM) is characterized by systolic ballooning of the left ventricular apex. It is triggered by emotional or physical stress, but the exact mechanism through which stress leads to TCM is not known. Hypothesis Coronary microvessel apoptosis is the missing link between stress and TCM. Methods In 8 female patients with TCM, plasma catecholamines, Thrombolysis in Myocardial Infarction (TIMI) coronary flow grade and myocardial perfusion grade, and apoptosis of the coronary microvessels in the biopsied myocardial specimen by terminal deoxynucleotidyl transferase‐mediated nick end‐labeling (TUNEL) were examined. Results Plasma epinephrine and norepinephrine were increased to 663 ± 445 and 875 ± 812 pg/mL (mean ± SD), respectively. Acetylcholine‐induced delayed myocardial perfusion through the ballooning apical segment without flow disturbance in the epicardial coronary arteries (indicating microvessel spasm) and focal myocardial necrosis were observed in all subjects. Apical ballooning disappeared and myocardial perfusion delay was not inducible 1 month later. The number of vessels having apoptotic endothelial cells/10 vessels in arterioles, venules, and capillaries at initial biopsy and repeat biopsy 1 month later were 8.3 ± 1.4 vs 0.4 ± 1.1, P < 0.0001; 6.8 ± 1.8 vs 0.3 ± 0.7, P < 0.0001; and 7.9 ± 1.0 vs 0.5 ± 0.9, P < 0.0001, respectively. Conclusions Left ventricular apical ballooning in TCM was considered to be caused by coronary microvessel spasm due to catecholamine‐induced endothelial cell apoptosis and myocardial stunning after release of microvessel spasm. Endothelial cell apoptosis of coronary microvessel is therefore considered to be the missing link between stress and TCM. Copyright © 2010 Wiley Periodicals, Inc.