Background Coronary artery tortuosity (CAT) is often viewed as a benign angiographic finding; however, emerging evidence suggests its potential hemodynamic significance, particularly in non-atherosclerotic cardiomyopathies such as Takotsubo syndrome (TS). This study aimed to investigate the prevalence and hemodynamic implications of CAT in patients diagnosed with Takotsubo cardiomyopathy (TCM) and to evaluate the association between the severity of tortuosity and myocardial injury markers, recovery of ventricular function, and other clinical variables.
Methods A retrospective review of 100 patients with Takotsubo cardiomyopathy (TCM) from the Baptist Memorial Hospital network (2015–2025) was conducted. Coronary artery tortuosity severity was quantified using angiographic criteria based on the number and degree of vessel curvatures in major epicardial arteries. Associations between coronary artery tortuosity and biochemical or echocardiographic parameters were evaluated using multiple linear regression and non-parametric tests.
Results CAT was highly prevalent (85.1%) in this TCM cohort, with a mean tortuosity index of 3.26-significantly higher than in general angiography populations. No significant correlations were found between tortuosity severity and peak troponin levels (P = 0.588) or ejection fraction (EF) at presentation (P = 0.820). Full EF recovery (55–65%) at ≥ 3 months occurred in 70.7% of patients and was not significantly associated with prior cardiomyopathy, coronary artery tortuosity index or baseline troponin levels.
Conclusion Coronary artery tortuosity was highly prevalent in this cohort of patients with Takotsubo syndrome. However, tortuosity severity was not associated with markers of myocardial injury or recovery of ventricular function. These findings suggest that coronary tortuosity may represent a vascular phenotype frequently observed in Takotsubo syndrome, although its direct pathophysiologic role remains uncertain.
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