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November 16, 2011

Cardiovascular Magnetic Resonance Imaging for Diagnosis of Stress Cardiomyopathy—Reply

Author Affiliations

Author Affiliations: Department of Internal Medicine/Cardiology, University of Leipzig, Leipzig, Germany (Drs Eitel and Thiele) (ingoeitel@gmx.de); and Stephenson Cardiovascular Magnetic Resonance Centre at the Libin Cardiovascular Institute of Alberta, University of Calgary, Calgary, Canada (Dr Friedrich).

JAMA. 2011;306(19):2093-2094. doi:10.1001/jama.2011.1657

In Reply: Most patients with SC have angiographically normal coronary arteries or only mild atherosclerosis. However, obstructive coronary artery disease (CAD) may rarely coexist because of the high prevalence of SC in the population at risk for CAD. As demonstrated by our large multicenter study, SC patients are mostly elderly and have a high incidence of risk factors for CAD. As highlighted by Drs Chatterjee and Maitra, we included 16 patients (6%) with epicardial coronary artery stenosis of 75% or more. In all these patients, the coronary stenosis did not correspond to the area of wall motion abnormality, making the stenosis an unlikely explanation for the observed reversible ventricular dysfunction. Additionally, we excluded any ischemic necrosis in the area of wall motion abnormality. Therefore, we believe that excluding the diagnosis of SC on the sole basis of an incidental finding of CAD may not be justified in all cases. A case-by-case decision process seems more appropriate.