Association of myocardial bridging and LAD length with Takotsubo syndrome: A MINOCA cross-sectional study

Oscar Winnberg; Jens Jensen; Shams Y-Hassan; Loghman Henareh; Peder Sörensson; Olov Collste; Christina Ekenbäck; Magnus Lundin; Kenneth Caidahl; Stefan Agewall; Kerstin Cederlund; Jannike Nickander; Martin G Sundqvist; Claes Hofman-Bang; Patrik Lyngå; Eva Maret; Nondita Sarkar; Jonas Spaak; Martin Ugander; Irene Santos-Pardo; Per Tornvall; Elin Brolin

doi:10.1016/j.ijcard.2025.133950

Association of myocardial bridging and LAD length with Takotsubo syndrome: A MINOCA cross-sectional study

Int J Cardiol. 2025 Oct 3:443:133950. doi: 10.1016/j.ijcard.2025.133950. Online ahead of print.

Authors

Oscar Winnberg¹, Jens Jensen², Shams Y-Hassan³, Loghman Henareh³, Peder Sörensson⁴, Olov Collste⁵, Christina Ekenbäck⁶, Magnus Lundin⁷, Kenneth Caidahl⁷, Stefan Agewall⁸, Kerstin Cederlund⁹, Jannike Nickander⁷, Martin G Sundqvist¹⁰, Claes Hofman-Bang⁶, Patrik Lyngå¹⁰, Eva Maret⁷, Nondita Sarkar¹¹, Jonas Spaak⁶, Martin Ugander¹², Irene Santos-Pardo¹³, Per Tornvall¹⁰, Elin Brolin¹⁴

Affiliations

¹ Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Cardiology Unit, Södersjukhuset, Stockholm, Sweden. Electronic address: oscar.winnberg@ki.se.
² Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Capio Saint Görans Hospital, Stockholm, Sweden.
³ Department of Cardiology, Karolinska University Hospital, Karolinska Institutet, Stockholm, Sweden.
⁴ Coronary Artery Disease Area, Heart and Vascular Theme, Karolinska University Hospital, Stockholm, Sweden; Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
⁵ Cardiology Unit, Södersjukhuset, Stockholm, Sweden.
⁶ Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden.
⁷ Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden.
⁸ Karolinska Institutet, Department of Clinical Sciences, Danderyd Hospital, Division of Cardiovascular Medicine, Stockholm, Sweden; Institute of Clinical Medicine, University of Oslo, Oslo, Norway.
⁹ Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Södertälje Hospital, Södertälje, Sweden.
¹⁰ Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Cardiology Unit, Södersjukhuset, Stockholm, Sweden.
¹¹ Department of Medicine Solna, Karolinska Institutet, Stockholm, Sweden.
¹² Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden; The Kolling Institute, Royal North Shore Hospital, Sydney, Australia; Department of Clinical Physiology, Karolinska University Hospital, Stockholm, Sweden; Charles Perkins Centre, Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
¹³ Department of Clinical Science and Education, Södersjukhuset, Karolinska Institutet, Stockholm, Sweden; Unit of Cardiovascular Interventions, Heart Institute, Germans Trias i Pujol University Hospital, Badalona, Spain.
¹⁴ Department of Clinical Science, Intervention and Technology, Karolinska Institutet, Stockholm, Sweden; Department of Radiology, Capio Saint Görans Hospital, Stockholm, Sweden.

PMID: 41046874
DOI: 10.1016/j.ijcard.2025.133950

Abstract

Background: Takotsubo syndrome (TTS) is an acute cardiac condition triggered by emotional or physical stress, characterized by a catecholamine surge and transient left ventricular dysfunction. Although myocardial bridging (MB) and left anterior descending artery (LAD) length have been proposed as contributing factors, their roles in TTS remain uncertain. This study aimed to assess whether TTS is associated with MB or LAD length in a well-characterized myocardial infarction with non-obstructive coronary arteries (MINOCA) cohort.

Methods: We analyzed 183 participants from the prospective Stockholm Myocardial Infarction with Normal Coronaries (SMINC) 1 and 2 studies, which focused on MINOCA. All participants underwent coronary computed tomography angiography (CCTA) and invasive coronary angiography (ICA). MB was assessed with CCTA, and LAD length was measured using ICA. TTS patients (n = 60) were compared with MINOCA controls without TTS (n = 123).

Results: MB was present in 37 % of TTS patients and 42 % of controls, with no significant association observed (p = 0.523), including when stratified by partial or full encasement. LAD length did not differ significantly between groups (p = 0.088).

Conclusion: This study found no significant association between MB or LAD length and the occurrence of TTS. These results suggest that structural variations in the LAD are unlikely to play a major role in the development of TTS, underscoring the importance of exploring alternative pathophysiological mechanisms beyond coronary anatomy.

Keywords: Cardiovascular imaging; Coronary computed tomography angiography; Myocardial bridging; Takotsubo syndrome.