Клиническая и экспериментальная кардиология
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Multiterritorial Reversible Coronary Microvascular Dysfunction as the Main Determinant of Tako-Tsubo Cardiomyopathy

Leonarda Galiuto, Lazzaro Paraggio, Elisa Fedele and Alberto Ranieri De Caterina

Tako-tsubo cardiomiopathy (TTC), also known as apical ballooning syndrome or stress cardiomyopapthy, represents an intriguing emerging syndrome with still an uncertain categorization. Although TTC is still classified as cardiomyopathy, its clinical presentation frequently mimics an acute coronary syndrome (ACS), since TTC is usually characterized by acute chest pain associated with ST-segment abnormalities, frequently in anterior leads, and cardiac enzymes release [1]. At coronary angiography TTC patients have absent or mild coronary atherosclerosis and the typical pattern of apical to midventricular a-dyskynesia at ventriculography. Typically myocardial dysfunction completely recovers within days or weeks, thus conferring to TTC a good long-term prognosis. Some characteristics make TTC an intriguing disease: 1) in the majority of cases TTC is precipitated by an emotional or physical stressful event; 2) TTC usually occurs in female in postmenopausal age; 3) the extent of myocardial dysfunction is disproportionate to the usually mild cardiac enzyme release 4) regional wall motion abnormalities extend beyond a single epicardial vessel distribution [2]. With the aim of understanding the pathophysiology of TTC, these four peculiarities need to be further highlighted.