{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T18:30:57Z","timestamp":1783535457795,"version":"3.55.0"},"reference-count":13,"publisher":"Oxford University Press (OUP)","issue":"3","license":[{"start":{"date-parts":[[2022,7,29]],"date-time":"2022-07-29T00:00:00Z","timestamp":1659052800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2023,3,6]]},"abstract":"<jats:title>Abstract<\/jats:title><jats:sec><jats:title>Background<\/jats:title><jats:p>Thrombotic microangiopathy (TMA) syndromes include thrombotic thrombocytopenic purpura (TTP) and haemolytic uremic syndrome, and contribute to myocardial infarction and multiple organ failure. Although coronary microvascular dysfunction (CMD) is the key for understanding the pathophysiology of cardiac involvement in TMA, there is limited knowledge on the recovery from CMD in patients with TMA.<\/jats:p><\/jats:sec><jats:sec><jats:title>Case summary<\/jats:title><jats:p>An 80-year-old woman was brought to the emergency department due to worsening back pain, dyspnoea on exertion, jaundice, and fever. Although she had typical TTP symptoms and elevated cardiac troponin level, ADAMTS13 activity was preserved (34%), leading to the diagnosis of TMA with myocardial infarction. She underwent plasma exchange and was administered aspirin and prednisolone. Magnetic resonance imaging revealed iliopsoas abscess, which is a possible aetiologic factor of sepsis-related TTP. She had impaired coronary flow reserve (CFR) with angiographically non-obstructive epicardial coronary arteries. Improved CFR was observed on follow-up, suggesting existence of transient CMD caused by TMA. After treatment of the iliopsoas abscess with antibiotics for 3 months, she was discharged without any adverse complications.<\/jats:p><\/jats:sec><jats:sec><jats:title>Discussion<\/jats:title><jats:p>Coronary microvascular dysfunction is an underlying mechanism of myocardial infarction, with or without epicardial obstructive coronary artery stenosis. TMA is characterized by pathological lesions caused by endothelial cell damage in small terminal arteries and capillaries, with complete or partial occlusion caused by platelet and hyaline thrombi. CMD and its recovery are keys for understanding the natural history of cardiac involvement in TMA. In vivo evaluations of CMD can provide mechanistic insights into the cardiac involvement in TMA.<\/jats:p><\/jats:sec>","DOI":"10.1093\/ehjcr\/ytac318","type":"journal-article","created":{"date-parts":[[2022,7,29]],"date-time":"2022-07-29T09:09:13Z","timestamp":1659085753000},"source":"Crossref","is-referenced-by-count":4,"title":["Evaluations of coronary microvascular dysfunction in a patient with thrombotic microangiopathy and cardiac troponin elevation: a case report"],"prefix":"10.1093","volume":"7","author":[{"ORCID":"https:\/\/orcid.org\/0000-0003-1359-3143","authenticated-orcid":false,"given":"Kenichiro","family":"Otsuka","sequence":"first","affiliation":[{"name":"Department of Cardiovascular Medicine, Fujiikai Kashibaseiki Hospital , 3300-3 Anamushi, Kashiba , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7002-0205","authenticated-orcid":false,"given":"Yasushi","family":"Kono","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Fujiikai Kashibaseiki Hospital , 3300-3 Anamushi, Kashiba , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-6780-7034","authenticated-orcid":false,"given":"Kumiko","family":"Hirata","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Fujiikai Kashibaseiki Hospital , 3300-3 Anamushi, Kashiba , Japan"},{"name":"Department of Medical Science, Osaka Educational University , Kashiwara, Osaka , Japan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"286","published-online":{"date-parts":[[2022,7,29]]},"reference":[{"key":"2023031709552894000_","doi-asserted-by":"crossref","first-page":"654","DOI":"10.1056\/NEJMra1312353","article-title":"Syndromes of thrombotic microangiopathy","volume":"371","author":"George","year":"2014","journal-title":"N Engl J Med"},{"key":"2023031709552894000_","doi-asserted-by":"crossref","first-page":"311","DOI":"10.1111\/j.1600-0609.2008.01112.x","article-title":"Myocardial infarction in thrombotic thrombocytopenic purpura: a single-center experience and literature review","volume":"81","author":"Wahla","year":"2008","journal-title":"Eur J Haematol"},{"key":"2023031709552894000_","doi-asserted-by":"crossref","first-page":"407","DOI":"10.1093\/eurheartj\/ehz425","article-title":"2019 ESC guidelines for the diagnosis and management of chronic coronary syndromes","volume":"41","author":"Knuuti","year":"2020","journal-title":"Eur Heart J"},{"key":"2023031709552894000_","doi-asserted-by":"crossref","first-page":"48","DOI":"10.1038\/nrcardio.2014.160","article-title":"Coronary microvascular dysfunction: mechanisms and functional assessment","volume":"12","author":"Camici","year":"2015","journal-title":"Nat Rev Cardiol"},{"key":"2023031709552894000_","doi-asserted-by":"crossref","first-page":"323","DOI":"10.1111\/j.1365-2141.2012.09167.x","article-title":"Guidelines on the diagnosis and management of thrombotic thrombocytopenic purpura and other thrombotic microangiopathies","volume":"158","author":"Scully","year":"2012","journal-title":"Br J Haematol"},{"key":"2023031709552894000_","doi-asserted-by":"crossref","first-page":"1665","DOI":"10.1016\/j.amjcard.2011.07.028","article-title":"Comparison of coronary microcirculation in female nurses after day-time versus night-time shifts","volume":"108","author":"Kubo","year":"2011","journal-title":"Am J Cardiol"},{"key":"2023031709552894000_","doi-asserted-by":"crossref","first-page":"A1262","DOI":"10.1016\/j.chest.2019.08.1137","article-title":"An atypical presentation of thrombotic thrombocytopenic purpura with concurrent acute coronary syndrome and cerebrovascular accident","volume":"156","author":"Samuel","year":"2019","journal-title":"Chest"},{"key":"2023031709552894000_","doi-asserted-by":"crossref","first-page":"382","DOI":"10.1111\/j.1537-2995.2007.01534.x","article-title":"Clinical cardiac involvement in thrombotic thrombocytopenic purpura: a systematic review","volume":"48","author":"Hawkins","year":"2008","journal-title":"Transfusion"},{"key":"2023031709552894000_","doi-asserted-by":"crossref","first-page":"293","DOI":"10.1111\/jth.12790","article-title":"Cardiac troponin-I on diagnosis predicts early death and refractoriness in acquired thrombotic thrombocytopenic purpura. 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