Takotsubo syndrome is a coronary microvascular disease: experimental evidence

Background and aims Takotsubo syndrome (TTS) is a conundrum without consensus about the cause. In a murine model of coronary microvascular dysfunction (CMD), abnormalities in myocardial perfusion played a key role in the development of TTS. Methods and results Vascular Kv1.5 channels connect coronary blood flow to myocardial metabolism and their deletion mimics the phenotype of CMD. To determine if TTS is related to CMD, wild-type (WT), Kv1.5(-/-), and TgKv1.5(-/-) (Kv1.5(-/-) with smooth muscle-specific expression Kv1.5 channels) mice were studied following transaortic constriction (TAC). Measurements of left ventricular (LV) fractional shortening (FS) in base and apex, and myocardial blood flow (MBF) were completed with standard and contrast echocardiography. Ribonucleic Acid deep sequencing was performed on LV apex and base from WT and Kv1.5(-/-) (control and TAC). Changes in gene expression were confirmed by real-time-polymerase chain reaction. MBF was increased with chromonar or by smooth muscle expression of Kv1.5 channels in the TgKv1.5(-/-). TAC-induced systolic apical ballooning in Kv1.5(-/-), shown as negative FS (P < 0.05 vs. base), which was not observed in WT, Kv1.5(-/-) with chromonar, or TgKv1.5(-/-). Following TAC in Kv1.5(-/-), MBF was lower in LV apex than in base. Increasing MBF with either chromonar or in TgKv1.5(-/-) normalized perfusion and function between LV apex and base (P = NS). Some genetic changes during TTS were reversed by chromonar, suggesting these were independent of TAC and more related to TTS. Conclusion Abnormalities in flow regulation between the LV apex and base cause TTS. When perfusion is normalized between the two regions, normal ventricular function is restored.