Broken-Heart Syndrome Linked to Endothelial Dysfunction

Heart Vessels. 2017 Oct 13. doi: 10.1007/s00380-017-1062-8. [Epub ahead of print]

Correlation between endothelial dysfunction and myocardial damage in acute phase of Tako-Tsubo cardiomyopathy: brachial flow mediated dilation as a potential marker for assessment of patient with Tako-Tsubo.

Carbonara R1, Giardinelli F2, Pepe M2, Luzzi G2, Panettieri I3, Vulpis V4, Bortone AS5, Ciccone MM2.

Author information

1
Department of Emergency and Organ Transplant, Cardiology Unit, Bari University Hospital, Piazza Giulio Cesare, 11, 70124, Bari, Italy. rossellacarbonara@hotmail.it.
2
Department of Emergency and Organ Transplant, Cardiology Unit, Bari University Hospital, Piazza Giulio Cesare, 11, 70124, Bari, Italy.
3
Department of Medicine, Foggia University Hospital, Viale Pinto, 1, 71100, Foggia, Italy.
4
Department of Medicine “Pende-Ferrannini”, Bari University Hospital, Piazza Giulio Cesare, 11, 70124, Bari, Italy.
5
Department of Cardiac Surgery, Bari University Hospital, Piazza Giulio Cesare, 11, 70124, Bari, Italy.

Abstract

Takotsubo cardiomyopathy (TTC) is characterized by transient systolic ventricular dysfunction. It is supposed to be caused by a cathecolaminergic wave which leads to myocardial stunning through a massive action on beta2-adrenoreceptor. Moreover, beta2-receptor hyperactivity negatively influences endothelial function. It can be detected by brachial flow mediated dilation (b-FMD) which assesses endothelium regulated vasomotility. The study aim is to analyze the b-FMD variability during hospitalization in 50 patients admitted with TTC. In addition, we investigated a possible correlation between b-FMD at admission and both length of hospital stay (LOHS) and troponin I peak. We detected b-FMD by measuring the hypoxic induced vasoreactivity through assessing brachial artery dilation after 5 min of iatrogenic ischemia obtained by inflating a sphygmomanometer cuff. Artery diameter modifications were assessed by high-resolution ultrasound, and a dedicated software calculated accurately the percentage of dilation after ischemia by comparing it to the basal. These values were measured at admission and on discharge. The obtained values were compared for each patient to explore their variability during hospitalization. Moreover, the correlation between the b-FMD at admission and both the troponin I peak and the LOHS was investigated. There was a statistical significant difference between mean FMD measured at admission and at discharge (respectively 1.54 ± 0.34 and 8.92 ± 2.48%; p < 0.001). Moreover, we found a significant negative correlation between troponin I peak and FMD values at admission (r = – 0.7645; p < 0.001) and a significant inverse correlation between FMD at admission and LOHS (r = – 0.7543; p < 0.001). There is a significant improvement of b-FMD during hospitalization in patients admitted for Tako-Tsubo Cardiomyopathy. Moreover, for the first time, a direct correlation among b-FMD, troponin I peak and LOHS has been detected.

KEYWORDS:

Catecholaminergic wave; Flow mediated dilation; Hospitalization length; TakoTsubo cardiomyopathy; Troponin peak

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