Qiong Qiu1, Mahmoud Abdelghany2, Rogin Subedi2, Ernest Scalzetti3, David Feiglin3, Jingfeng Wang4, Kan Liu5. 1. Division of Cardiology, State University of New York, Upstate Medical University, Syracuse, NY 13202, United States of America; Division of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China. 2. Division of Cardiology, State University of New York, Upstate Medical University, Syracuse, NY 13202, United States of America. 3. Department of Radiology, State University of New York, Upstate Medical University, Syracuse, NY 13202, United States of America. 4. Division of Cardiology, Sun Yat-sen Memorial Hospital of Sun Yat-sen University, Guangzhou 510120, China. Electronic address: dr_wjf@vip.163.com. 5. Division of Cardiology, State University of New York, Upstate Medical University, Syracuse, NY 13202, United States of America. Electronic address: Kan-Liu@uiowa.edu.
Abstract
BACKGROUND: In patients with acute anterior myocardial infarction (MI), sometimes an "apical ballooning" contractile dysfunction pattern that exceeds factual myocardial injury is identified in the ventriculography and bedside echocardiography. The hemodynamic consequences/sequela of this "Tako-tsobu effect" has not been well delineated. Of note, this anatomic imaging finding often misleads frontline physicians who assume reciprocal causation of persistent cardiac pump failure and ventricular pressure overload. METHODS AND RESULTS: Using real-time myocardial perfusion contrast echocardiography (MCE), we investigated myocardial (microvascular) perfusion in 60 patients after acute MI and coronary revascularization. Twenty-eight percent of the studied patients showed significantly mismatched myocardial perfusion and contractile defects. In these patients, an integrated imaging assessment with coronary angiography/ventriculography, deformation echocardiography, and MCE proved that the myocardial mechanic abnormalities significantly exceeded the defected perfusion areas. Compared with 72% of the patients without perfusion-contractility mismatch, apparently worse systolic functions (left ventricular ejection, wall motion score, and systolic longitudinal strain) in these patients did not change diastolic ventricular filling pressures (E/E' and E/A) or hemodynamic consequences/adverse events. Both systolic and diastolic functions in patients with perfusion-contractility mismatch appeared to be comparable with those in patients with Tako-tsubo syndrome. CONCLUSIONS: Real-time MCE identifies discrepant myocardial microvascular perfusion and mechanics in patients with acute MI. The "Tako-tsubo effect" in patients with perfusion-contractility mismatch does not cause diastolic filling pressure change or worse hemodynamic consequence/cardiac event.
BACKGROUND: In patients with acute anterior myocardial infarction (MI), sometimes an "apical ballooning" contractile dysfunction pattern that exceeds factual myocardial injury is identified in the ventriculography and bedside echocardiography. The hemodynamic consequences/sequela of this "Tako-tsobu effect" has not been well delineated. Of note, this anatomic imaging finding often misleads frontline physicians who assume reciprocal causation of persistent cardiac pump failure and ventricular pressure overload. METHODS AND RESULTS: Using real-time myocardial perfusion contrast echocardiography (MCE), we investigated myocardial (microvascular) perfusion in 60 patients after acute MI and coronary revascularization. Twenty-eight percent of the studied patients showed significantly mismatched myocardial perfusion and contractile defects. In these patients, an integrated imaging assessment with coronary angiography/ventriculography, deformation echocardiography, and MCE proved that the myocardial mechanic abnormalities significantly exceeded the defected perfusion areas. Compared with 72% of the patients without perfusion-contractility mismatch, apparently worse systolic functions (left ventricular ejection, wall motion score, and systolic longitudinal strain) in these patients did not change diastolic ventricular filling pressures (E/E' and E/A) or hemodynamic consequences/adverse events. Both systolic and diastolic functions in patients with perfusion-contractility mismatch appeared to be comparable with those in patients with Tako-tsubo syndrome. CONCLUSIONS: Real-time MCE identifies discrepant myocardial microvascular perfusion and mechanics in patients with acute MI. The "Tako-tsubo effect" in patients with perfusion-contractility mismatch does not cause diastolic filling pressure change or worse hemodynamic consequence/cardiac event.
Authors: Trine Moholdt; Clifford Afoakwah; Paul Scuffham; Christine F McDonald; Louise M Burrell; Simon Stewart Journal: BMC Public Health Date: 2021-03-20 Impact factor: 3.295
Authors: Fahim Zaman; Rakesh Ponnapureddy; Yi Grace Wang; Amanda Chang; Linda M Cadaret; Ahmed Abdelhamid; Shubha D Roy; Majesh Makan; Ruihai Zhou; Manju B Jayanna; Eric Gnall; Xuming Dai; Avneet Singh; Jingsheng Zheng; Venkata S Boppana; Feng Wang; Pahul Singh; Xiaodong Wu; Kan Liu Journal: EClinicalMedicine Date: 2021-09-04