Abstract 15854: Prevalence and Clinical Significance of Left Ventricular Outflow Tract Obstruction in Patients With Takotsubo Cardiomyopathy
Introduction: Takotsubo cardiomyopathy (TTC) is regarded a benign disease since left ventricular function normalizes within a short time. However, a number of complications have been observed in patients (pts) with this syndrome.
This study evaluated the frequency and clinical significance of left ventricular outflow tract obstruction (LVOTO) in a large TTC registry.
Methods: From 37 heart centres, 324 pts (296 f, 28 m, age 68±12) were included in a registry according to established TTC criteria. Complete data on complications were available in the last 209 registry pts, and those with and without LVOTO were compared.
Results: Complications developed in 108/209 pts (52%) within 2.6±2.9 days after symptom onset; 51 of these pts (24%) experienced >1 complication. Most complications (77%) occurred within 3 days after symptom onset, however, 23% developed later (day 4 to 56).
During the acute phase, LVOTO (ranging from 20-100 mm Hg) was seen in 10/209 pts (5%). LVOTO occurred within the first 2 days after hospital admission in 7 pts (70%) and developed between day 3 and day 10 in 3 pts. Inotropic agents had been administered in 1 pt. Age, sex and symptoms were comparable in pts with or without LVOTO. The admission ECG showed a higher heart rate in association with LVOTO (101±15/min vs 87±23/ min, p=0.05); other ECG parameters were not different. Cardiac markers were lower with LVOTO (CK 1.67±1.2 vs 1.97±4.1, and troponin 11.7±9.4 vs 21.4±56.3 x upper limit of normal, p=0.05). Angiographic ejection fraction was comparable in both groups (50±14% vs 51±15%). LVOTO occurred with similar frequency in mid-ventricular and in apical ballooning (2/76 vs 8/133, p=ns). Transient mitral regurgitation (≥ grade II) was only seen in pts with LVOTO (2/10 vs 0/199, p<0.002). Other complications (LV thrombus or stroke, pulmonary edema, arrhythmias, shock, death) were observed with similar frequency in both groups. Under betablocker therapy LVOTO resolved within 2-3 days in every patient.
Conclusion: LVOTO occurs in 5% of pts with TTC and may be associated with high grade mitral regurgitation. Since catecholamines can provoke or aggravate LVOTO, inotropic agents should be used only under echocardiographic guidance. With betablocker therapy LVOTO resolves within 3 days.
Author Disclosures: B. Schneider: None. A. Athanasiadis: None. J. Schwab: None. W. Pistner: None. U. Gottwald: None. W. Toepel: None. R. Schoeller: None. K. Winter: None. T. Müller-Honold: None. U. Sechtem: None.
- © 2014 by American Heart Association, Inc.