Abstract 16823: Prevalence and Clinical Relevance of Right Ventricular Involvement in Patients With Takotsubo Cardiomyopathy - an Echocardiographic Study
Purpose: Takotsubo cardiomyopathy (TTC) is a transient form of acute heart failure. Besides ballooning of the left ventricle (LV), some patients develop wall motion abnormalities of the right ventricle (RV).
This study assessed the prevalence, clinical significance and time course of RV involvement in patients with TTC by echocardiographic follow-up.
Methods: Over a 10-year period, we observed 88 TTC patients (79f, 9m, age 71±12). By echocardiography, 24 pts (27%) had RV involvement. Clinical parameters, ECG, echocardiographic and angiographic findings were compared in patients with and without RV involvement.
Results: RV wall motion abnormalities involved the apicolateral (n=16), mediolateral (n=4), anterolateral (n=2) and inferior (n=2) segments. Normalization of RV contraction always occurred before normalization of LV function (10±6 vs 22±17 days).
In patients with RV involvement, time from symptom onset to hospital admission was shorter (6.3±6.1 vs 9.8±10.2 hours, p=0.05). The ECG on admission showed a higher heart rate (98±23 vs 86±22 beats per minute, p<0.05), and more patients with RV involvement developed giant negative T waves during follow-up (55% vs 16%, p<0.001). Other ECG parameters were not different. Troponin was higher in RV involvement (12±10 vs 7±6.5 x upper limit of normal, p=0.03). Angiographic ballooning pattern of the LV and end-diastolic LV pressure were similar in both groups. LV ejection fraction, however, was significantly lower in patients with RV involvement (45±12 vs 53±13 %, p=0.01).
Overall, patients with RV involvement more frequently developed complications (58% vs 39%, p=0.05) and especially severe complications (29% vs 8%, p<0.01) during the acute clinical course. There was a higher frequency of ventricular tachycardia (17% vs 5%, p=0.05) and acute mitral regurgitation (13% vs 3%, p<0.03) in patients with RV involvement. Time to complete normalisation of LV function was longer (29±25 vs 20±13 days, p<0.05).
Conclusion: As assessed by echocardiography, RV involvement occurs in 27% of patients with TTC and is associated with a significantly higher rate of severe complications. Since ventricular tachycardia is frequently observed, prolonged monitoring is advisable in these patients.
- © 2013 by American Heart Association, Inc.