P446Right ventricular involvement in Takotsubo cardiomyopathy


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Abstract

Takotsubo cardiomyopathy, characterized as transient left ventricular (LV) wall motion abnormalities triggered by severe stress, without associated coronary artery disease, has essentially a good prognosis. Objetive: To assess right ventricular (RV) involvement and outcome we evaluated all patients with diagnosis of Takotsubo cardiomyopathy from 2006 up to 2011 in our hospital.Methods: Takotsubo was defined as acute chest pain /dyspnea with ECG changes and elevation of cardiac enzymes, reversible LV regional wall motion abnormalities without a correspondent coronary territory, complemented by coronary arteriography/ tomography with no significant(>50% obstruction) disease. Patients were divided into Classical (akinesia/hipokinesia of mid/apical LV segments) and Inverted (no apical ballooning) forms. Results:18 patients (19 episodes) fulfilled criteria for Takotsubo; there were 17 female, with mean age of 63 ± 20 years. Main predisposing factors were post-operative (37%) and emotional stress (26%). Classical presentation was observed in 13 patients, while 6 had the Inverted form (akinesia of basal and mid LV segments in 4, akinesia restricted to mid segments in 1, and basal segments in 1 patient). LV ejection fraction (EF) was 36±11% at the onset of the disease. Time to regression of wall motion abnormalities was longer for Classical than Inverted form (14±8 vs 8±4 days, p=0.03), with complete normalization of LV function (EF= 64±5%). Right ventricular regional dysfunction was found in 6 patients (46%) in Classical form, but only 1 in Inverted form (p< 0.05), with complete RV functional recovery. Overall rate of complications was higher (p<0.05) for Classical form (Table), including LV thrombus, significant (>= grade II) mitral regurgitation, mild pericardial effusion and atrial fibrillation. Except for 5 patients (2 deaths, one pulmonary embolism, 1 cardiogenic shock and 1 resuscitated cardiac arrest), follow-up was excellent. In conclusion, RV impairment is more frequently found in Classical Takotsubo presentation; compared to Inverted form, Classical Takotsubo has a higher overall rate of complications.

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