Abstract 13894: “Reverse McConnell’s Sign”: A Unique Right Ventricular Mechanical and Functional Feature in Tako-Tsubo Cardiomyopathy
Introduction: Tako-Tsubo cardiomyopathy (TTC) can clinically mimic acute myocardial infarction (AMI) and induce pump failure and hemodynamic instability. Clinicians often face the challenge of differentiating the two without cardiac catheterization, especially when hemorrhagic stroke or severe trauma is the stressor for TTC and cardiac catheterization is contraindicated. Also, misdiagnosing TTC as AMI can lead to initiating inotropes which are known to cause further hemodynamic compromise in TTC. Therefore, distinguishing TTC from AMI with real time cardiovascular imaging other than coronary angiogram is crucial in these patients.
Hypothesis: Echocardiographic RV contractile and functional features can help differentiate TTC and AMI.
Methods: In a retrospective study, we compared echocardiographic RV contractile and functional features in 80 consecutive TTC patients and 75 AMI patients from September 2009 to February 2014.
Results: We identified a characteristic echocardiographic right ventricular (RV) contractile feature in TTC patients: hyperkinetic RV basal/mid walls with hypokinetic RV apex (Reverse McConnell’s sign). The frequency of RV hyperkinesis and Reverse McConnell’s sign was significantly different between TTC and AMI patients (81.3% vs 36.0%, 85.0% vs 34.7%, P < 0.05, respectively). TTC Patients also had higher RV ejection fraction (RVEF) and tricuspid regurgitation (TR) dp/dt than those with AMI (61.1% ± 13.2% vs 48.2% ± 14.1%, 1028.9 ± 456.8 vs 585.8 ± 287.7, P 1049 mm Hg/s alone (sensitivity = 65.8%, specificity = 86.2%, P < 0.05) or combination of RVEF > 54.5% and Reverse McConnell’s sign (sensitivity = 66.3%, specificity = 90.7%) had good diagnostic value. Logistic regression analysis showed that RVEF and Reverse McConnell’s sign were independent predictors of TTC.
Conclusions: The characteristic echocardiographic RV contractile/functional features help the diagnosis and management of TTC. The unique RV mechanics likely represents a contingent self-protective mechanism to limit catecholamine-induced myocardial injury and reduce hemodynamic compromise during the acute phase of TTC. To support, not disrupt, this “rescue” mechanism can avoid adverse outcome from pump failure and cardiogenic shock in TTC.[[Unable to Display Character:
Author Disclosures: A. Singh: None. J. Lei: None. H. Kozman: None. J. Wang: None. K. Liu: None.
- © 2014 by American Heart Association, Inc.