Coronary artery disease in Takotsubo cardiomyopathy

Background Significant coronary artery disease (CAD) is generally considered as an exclusion criterion for the diagnosis of takotsubo cardiomyopathy (TC). However, this may not be justified in all cases, because TC and CAD may coincide. Methods and Results Among 821 consecutive patients who underwent urgent left heart catheterization for suspected acute coronary syndrome between December 2004 and August 2006 those with a final diagnosis of TC who also had a stenotic lesion (diameter stenosis on quantitative coronary angiography > 50% and < 75%) of the left anterior descending artery were evaluated. Four patients met the inclusion criteria. Previous coronary angiograms were available for 2 of these patients and showed no change in the angiographic appearance of the lesions. Intravascular ultrasound study was performed in the other 2 patients and demonstrated negative remodeling and no signs of plaque rupture, thrombus, positive remodeling or intimal dissection. Conclusions The present study supports the notion that TC and CAD are not mutually exclusive disease entities. Excluding the diagnosis of TC on the sole basis of an incidental finding of CAD may not be justified in all cases. Rather, a case-by-case decision process seems more appropriate.