Coronary artery tree and myocardial perfusion in patients with tako-tsubo cardiomyopathy: Evaluation with coronary digital subtraction angiography.

Tako-tsubo cardiomyopathy is characterized by transient left ventricular contractile dysfunction. The precise etiology of tako-tsubo cardiomyopathy remains to be elucidated. We performed coronary angiography in two patients with tako-tsubo cardiomyopathy and evaluated the coronary microcirculation by digital subtraction angiography (DSA). In the acute phase of tako-tsubo cardiomyopathy, coronary DSA demonstrated severely reduced perfusion in the apex. Follow-up DSA showed the restoration of normal myocardial perfusion in the apex. Coronary DSA can simultaneously depict the coronary vessels and myocardial perfusion abnormalities. Furthermore, DSA can also show the relationship between the perfusion territory of the coronary arteries and the region of impaired myocardial perfusion. This technique might support the central role of microcirculation disturbance in tako-tsubo cardiomyopathy.