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The aim of our manuscript was to assess CMD in patients with TTS through the computation of the angiography-derived index of microcirculatory resistance (IMR) and its correlation with clinical presentation<jats:bold>.<\/jats:bold> Coronary angiograms of 41 consecutive TTS patients were retrospectively analyzed to derive angiography-based indices of CMD. Three indices (NH-IMRangio, AngioIMR and A-IMR) were calculated based on quantitative flow ratio. CMD was defined as an IMRangio value\u2009\u2265\u200925\u00a0units. The correlation between CMD and clinical presentation was then assessed. Median age was 76\u00a0years, 85.7% were women and mean left ventricular ejection fraction (LVEF) at first echocardiogram was 41.2%. Angiography-derived IMR was higher in left anterior descending artery (LAD) than circumflex and right coronary artery with either NH-IMRangio (53.9\u2009\u00b1\u200919.8 vs 35.8\u2009\u00b1\u200915.4 vs 40.8\u2009\u00b1\u200918.5, p-value\u2009&lt;\u20090.001), AngioIMR (47.2\u2009\u00b1\u200917.3 vs 31.8\u2009\u00b1\u200912.2 vs 37.3\u2009\u00b1\u200913.7, p-value\u2009&lt;\u20090.001) or A-IMR (52.7\u2009\u00b1\u200919 vs 36.1\u2009\u00b1\u200914.1 vs 41.8\u2009\u00b1\u200916.1, p-value\u2009&lt;\u20090.001). All patients presented CMD with angiography-derived IMR\u2009\u2265\u200925 in at least one territory with each formula. Angiography-derived IMR in LAD territory was significantly higher in patients presenting with LVEF impairment (\u2264\u200940%) than in those with preserved ventricular global function (NH-IMRangio: 59.3\u2009\u00b1\u200918.1 vs 46.3\u2009\u00b1\u200916.0 p-value\u2009=\u20090.030; AngioIMR: 52.9\u2009\u00b1\u200917.8 vs 41.4\u2009\u00b1\u200914.2, p-value\u2009=\u20090.037; A-IMR: 59.2\u2009\u00b1\u200918.6 vs 46.3\u2009\u00b1\u200917.0, p-value\u2009=\u20090.035). CMD assessed with angiography-derived IMR is a common finding in TTS and it is inversely correlated with LV function. The available formulas have a substantial superimposable diagnostic performance in assessing coronary microvascular function.<\/jats:p>","DOI":"10.1007\/s10554-022-02698-6","type":"journal-article","created":{"date-parts":[[2022,11,7]],"date-time":"2022-11-07T01:02:40Z","timestamp":1667782960000},"page":"233-244","update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":15,"title":["Angiography-derived index of microvascular resistance  in takotsubo syndrome"],"prefix":"10.1007","volume":"39","author":[{"given":"Gianluca","family":"Castaldi","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Simone","family":"Fezzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maddalena","family":"Widmann","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Micaela","family":"Lia","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Francesca","family":"Rizzetto","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Concetta","family":"Mammone","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Sara","family":"Pazzi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Solange","family":"Piccolo","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Verdiana","family":"Galli","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michele","family":"Pighi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gabriele","family":"Pesarini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniele","family":"Prati","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Valeria","family":"Ferrero","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Roberto","family":"Scarsini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Domenico","family":"Tavella","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Flavio","family":"Ribichini","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2022,11,7]]},"reference":[{"issue":"8","key":"2698_CR1","doi-asserted-by":"publisher","first-page":"1036","DOI":"10.1002\/ejhf.683","volume":"19","author":"JR Ghadri","year":"2017","unstructured":"Ghadri JR, Cammann VL, Jurisic S, Seifert B, Napp LC, Diekmann J et al (2017) A novel clinical score (InterTAK Diagnostic Score) to differentiate takotsubo syndrome from acute coronary syndrome: results from the International Takotsubo Registry. 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