PMID- 23002215
OWN - NLM
STAT- MEDLINE
DCOM- 20131114
LR  - 20161125
IS  - 2047-2412 (Electronic)
IS  - 2047-2404 (Linking)
VI  - 14
IP  - 5
DP  - 2013 May
TI  - Non-invasive detection of tako-tsubo cardiomyopathy vs. acute anterior myocardial 
      infarction by transthoracic Doppler echocardiography.
PG  - 464-70
LID - 10.1093/ehjci/jes192 [doi]
AB  - AIMS: Typical tako-tsubo cardiomyopathy (TTC) mimics acute anterior myocardial 
      infarction (AMI) and the differential diagnosis is challenging before coronary 
      angiography (CA) is performed; it demonstrates reduced or absent antegrade flow 
      in the left anterior descending artery (LAD) in AMI, whereas there is no such 
      flow limiting in TTC. At the acute phase, we tested the usefulness of the distal 
      LAD flow visualization by transthoracic Doppler echocardiography (TDE) to 
      distinguish between these two diseases. For this purpose, we prospectively 
      enrolled 28 consecutive patients with TTC (75 +/- 10 years, 93% females) who were 
      compared with 28 consecutive patients with AMI treated successfully by primary 
      angioplasty (66 +/- 12 years, 79% females). All the patients underwent the 
      assessment of the distal LAD flow just before CA, using colour and pulsed-wave 
      TDE. In addition, the symmetric involvement of wall motion abnormalities (WMAs) 
      based on the extent of the disease far beyond one coronary territory in TTC was 
      searched by TDE. Non-invasive coronary flow reserve (CFR) by TDE, in the distal 
      LAD, was also performed within 1 day after admission. RESULTS: Before CA, the 
      distal LAD flow was visible in 38 of 56 cases (68%) in the whole population, in 
      all cases with TTC and in 10 cases with AMI (36%). The sensitivity (Se) and 
      specificity (Sp) of the LAD flow visualization for the diagnosis of TTC were 100 
      and 64%, respectively, with a diagnostic accuracy of 82%. In comparison, the 
      pattern of WMA yielded a Se of 75% and Sp of 86%, and a diagnostic accuracy of 
      80%. With the combination of both tools, the Se and Sp to detect TTC were 75 and 
      96% respectively, with a diagnostic accuracy of 86%. After CA, the acute CFR was 
      less severely impaired in the TTC group when compared with the AMI group (2.2 +/- 
      0.5 vs. 1.7 +/- 0.6, P < 0.01) despite a worse LV systolic dysfunction. CONCLUSION: 
      Non-invasive evaluation of the distal LAD flow could be helpful to differentiate 
      TTC from AMI, and its combination with the pattern of WMA improved slightly its 
      diagnostic accuracy. Furthermore, the acute CFR is less severely impaired in TTC 
      compared with AMI despite poorer LV systolic dysfunction, suggesting that other 
      mechanisms than direct microcirculatory damage are also involved in the 
      pathogenesis of WMAs in TTC.
FAU - Meimoun, Patrick
AU  - Meimoun P
AD  - Department of Cardiology, Centre Hospitalier De Compiegne, 8 Rue Henri Adnot, 
      Compiegne 60200, France. patrickmeimoun.md@gmail.com
FAU - Clerc, Jerome
AU  - Clerc J
FAU - Vincent, Charles
AU  - Vincent C
FAU - Flahaut, Florent
AU  - Flahaut F
FAU - Germain, Anne Laure
AU  - Germain AL
FAU - Elmkies, Frederic
AU  - Elmkies F
FAU - Zemir, Hamdane
AU  - Zemir H
FAU - Luycx-Bore, Anne
AU  - Luycx-Bore A
LA  - eng
PT  - Comparative Study
PT  - Journal Article
DEP - 20120921
PL  - England
TA  - Eur Heart J Cardiovasc Imaging
JT  - European heart journal. Cardiovascular Imaging
JID - 101573788
SB  - IM
MH  - Age Factors
MH  - Aged
MH  - Aged, 80 and over
MH  - Analysis of Variance
MH  - Anterior Wall Myocardial Infarction/diagnosis/*diagnostic imaging/mortality
MH  - Cohort Studies
MH  - Coronary Angiography/methods
MH  - Coronary Circulation/physiology
MH  - Diagnosis, Differential
MH  - Echocardiography/*methods
MH  - Female
MH  - Humans
MH  - Male
MH  - Observer Variation
MH  - Prospective Studies
MH  - Risk Assessment
MH  - Severity of Illness Index
MH  - Sex Factors
MH  - Survival Rate
MH  - Takotsubo Cardiomyopathy/diagnosis/*diagnostic imaging/mortality
MH  - Tomography, X-Ray Computed/methods
EDAT- 2012/09/25 06:00
MHDA- 2013/11/15 06:00
CRDT- 2012/09/25 06:00
PHST- 2012/09/25 06:00 [entrez]
PHST- 2012/09/25 06:00 [pubmed]
PHST- 2013/11/15 06:00 [medline]
AID - jes192 [pii]
AID - 10.1093/ehjci/jes192 [doi]
PST - ppublish
SO  - Eur Heart J Cardiovasc Imaging. 2013 May;14(5):464-70. doi: 10.1093/ehjci/jes192. 
      Epub 2012 Sep 21.