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Coincidence of coronary artery disease and Tako-Tsubo cardiomyopathy

Koinzidenz von koronarer Herzkrankheit und Tako-Tsubo Kardiomypathie

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Abstract

Tako-Tsubo cardiomyopathy (TTC) predominantly affects elderly people with a high prevalence of cardiovascular risk factors. Therefore, one would expect to encounter incidental coronary artery disease in a significant number of cases. In fact, the prevalence of mild coronary artery disease (CAD), by angiography, has been reported to be in the range of 30%–60%. Similarly, more severe stenotic lesions in at least one coronary vessel were incidentally found in 10%–35% of patients with the disease. Using intravascular ultrasound in a series of 10 patients with TTC, coronary atherosclerosis was demonstrable in all patients, although five patients had normal coronary angiograms. Therefore, TTC and CAD are not mutually exclusive disease entities. The incidental finding of coronary lesions, even if significant, should not automatically lead to a dismissal of the diagnosis of TTC. Rather, a case-by-case approach using additional imaging modalities should be endorsed.

Zusammenfassung

Die Tako-Tsubo Kardiomyopathie (TTC) betrifft vornehmlich ältere Menschen, bei denen naturgemäß eine hohe Prävalenz kardiovaskulärer Risikofaktoren vorliegt. Deshalb kann davon ausgegangen werden, dass die koronare Herzerkrankung (KHK) und die TTC häufig gemeinsam vorkommen. In der Tat zeigen Studien, dass milde Formen der koronaren Herzerkrankung in 30 bis 60% der Fälle nachweisbar sind. Höhergradige Stenosen in mindestens einem Koronargefäß kommen in 10 bis 35% der Fälle vor. In einer kleinen Studie mit 10 Patienten konnte mit Hilfe des intravaskulären Ultraschalls sogar gezeigt werden, dass alle 10 Patienten der Studie mit TTC eine Atherosklerose der Kranzgefäße aufwiesen, obwohl 5 Patienten koronarangiographisch normale Kranzgefäße hatten. Deshalb ist festzuhalten, dass sich die TTC und die KHK nicht ausschließen und durchaus gemeinsam vorkommen können. In unklaren Fällen sollte, gegebenenfalls unter Zuhilfenahme weiterer bildgebender Verfahren, individuell entschieden werden, um welche Entität es sich handelt.

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The corresponding author states that there are no conflicts of interest.

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Authors and Affiliations

  1. I. Medizinische Klinik, Universitätsklinikum Mannheim, 68167, Mannheim, Deutschland

    D. Haghi, K. Hamm, F. Heggemann, T. Walter, T. Suselbeck, T. Papavassiliu & M. Borggrefe

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  1. D. Haghi
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  2. K. Hamm
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  3. F. Heggemann
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  4. T. Walter
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  5. T. Suselbeck
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  6. T. Papavassiliu
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  7. M. Borggrefe
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Correspondence to D. Haghi.

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Haghi, D., Hamm, K., Heggemann, F. et al. Coincidence of coronary artery disease and Tako-Tsubo cardiomyopathy. Herz 35, 252–257 (2010). https://doi.org/10.1007/s00059-011-3447-2

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