P446Right ventricular involvement in Takotsubo cardiomyopathy

    loading  Checking for direct PDF access through Ovid


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.

    loading  Loading Related Articles