Can Acute Occlusion of the Left Anterior Descending Coronary Artery Produce a Typical "Takotsubo" Left Ventricular Contraction Pattern?

The takotsubo syndrome (TS) takes its name from a distinctive left ventricular (LV) contraction abnormality. Patients with this disorder present with clinical findings of an acute ischemic event. Despite the absence of obstructive coronary artery disease, there is a hallmark LV contraction abnormality, namely hypercontractility of the base but akinesia or dyskinesis of the apex. Many discount a role for the epicardial coronary arteries in this disorder because the LV contraction abnormality appears to overlap >1 vascular territory. To test this assumption we analyzed the contraction pattern associated with left anterior descending coronary artery (LAD) occlusion. From May to September 2006, 43 patients underwent primary percutaneous coronary intervention for acute ST-elevation myocardial infarction due to LAD occlusion. Their left ventriculograms were randomly mixed with those of 47 patients clinically labeled as TS. Two reviewers unaware of the clinical diagnosis characterized the LV contraction pattern of all 90 as typical of TS or not. In 6 of the 43 patients (14%) with primary PCI the 2 reviewers considered the pattern to be typical, and in 5 (12%), 1 of 2 reviewers did. Thus, in 26% ≥1 reviewer believed that the pattern associated with LAD occlusion was typical of TS. In conclusion, the characteristic TS contraction pattern may be seen in some patients with acute occlusion of the LAD. It would be premature to dismiss the possibility of transient LAD occlusion as part of the pathogenesis of that disorder.