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To determine if Thrombolysis In Myocardial Infarction (TIMI) Frame Count is a useful tool in determining the coronary blood flow in patients with Takotsubo Cardiomyopathy (TC) vs normal controls.
Takotsubo Cardiomyopathy is characterized by transient dilatation of the left ventricle apex or other segments in patients usually with high adrenergic state following a stressful event. Patients may present with acute coronary syndrome with ST elevation and signs and symptoms of coronary artery disease (CAD). Coronary angiography in TC however does not show any significant coronary artery disease. TIMI Frame Count (TFC) is the cine frames required for dye to first reach a standardized distal coronary land mark and is an objective and quantitative index of coronary blood flow. Faster corrected TIMI Frame Count has been shown to have a lower in-hospital mortality and better clinical outcome.
16 patients with TC who presented with an acute anterior ST elevation were retrospectively compared with randomly chosen controls without significant coronary artery disease on angiography. TIMI Frame Count was calculated in all coronary blood vessels. Left anterior descending (LAD) artery values were adjusted to get corrected TIMI Frame Count (CTFC). This was calculated by applying a correction factor and making adjustments for the longer length of LAD.
TIMI Frame Count in LAD of Takotsubo Cardiomyopathy patients was significantly higher. This was statistically significant with a mean value of 19.61 vs 16.65 for controls with a p value 0.04. No differences were noted between two groups in other vessels. All the cases of TC were females. Age and traditional risk factors for CAD were comparable in two groups but controls had more diabetics.
In patients with Takotsubo Cardiomyopathy, TIMI Frame Count is abnormal in LAD and its territory suggesting either endothelial dysfunction and microvascular disease or both. TFC may be a useful adjunctive tool in the setting of this disease entity. More studies are needed to compare it to the patients with acute MI due to coronary artery disease involving the LAD.
Poster Sessions, Expo North
Saturday, March 09, 2013, 10:00 a.m.-10:45 a.m.
Session Title: Stress, Coronary Spasm and AMI: Lessons from Japan, New Orleans, Greece
Abstract Category: 1. Acute Coronary Syndromes: Clinical
Presentation Number: 1130-210
- 2013 American College of Cardiology Foundation