Tortuosity, Recurrent Segments, and Bridging of the Epicardial Coronary Arteries in Patients With the Takotsubo Syndrome

Myocardial bridging (MB) and a long recurrent wraparound left anterior descending artery(wrap-LAD) are coronary anatomic variants that have been recently suggested to beassociated with takotsubo syndrom e (TS). Until now, coronary artery tortuosity (CAT) hasnever been investigated in this setting. Our study sought to evaluate the prevalence of theaforementioned anatomic variants in a large population with TS. In this retrospectiveangiographic study, 109 patients with TS were compared with 109 age- and gender-matched subjects without coronary artery disease, va lve heart disease, or cardiomyopa-thy. CAT was identi fied by ‡3 consecutive curvatures ‡90(criteria 1) or by ‡2 consecutivecurvatures ‡180(criteria 2). Wrap-LAD was defined if any part of the vessel outreachedthe apex of the left ventricle and MB as the presence of a milking effect or a step-up andstep-down phenomenon. An anatomic variant was found in 79 patients with TS (72%) andin 48 controls (44%) (p <0.001). CAT in at least 1 vessel (criteria 1: 49% vs 20%, p <0.001;criteria 2: 38% vs 13%, p <0.001), ‡2 vessels (criteria 2: 14% vs 3%, p [ 0.005), and wrap-LAD (41% vs 27%, p [ 0.02) were signi ficantly more frequent in patients with TS than incontrols. The prevalence of MB (9% vs 5%, p [ 0.18) did not differ between groups. Inconclusion, CAT and wrap-LAD have higher prevalence in patients with TS than inmatched controls. These findings could support the hypothesis that anatomic variantsmight act as potential pathogenic substrates in TS.