Right Ventricular Abnormalities in Takotsubo Cardiomyopathy

Rodrigues, Ana Clara Tude; Guimarães, Laise; Lira, Edgar; Oliveira, Wercules; Monaco, Claudia; Cordovil, Adriana; Fischer, Cláudio Henrique; Vieira, Marcelo Luiz Campos; Morhy, Samira Saady

doi:10.1111/echo.12215

Cited by 16 publications

(12 citation statements)

References 14 publications

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“…3,4 In the present case, the LAD was patent when regional wall-motion abnormalities of the LV and RV developed, even though the patient had undergone a percutaneous coronary intervention for LAD 2 years before. 1,2 Other variants including biventricular involvements were described recently.…”

Section: Discussionmentioning

confidence: 56%

Evolutionary Change Mimicking Apical Hypertrophic Cardiomyopathy in a Patient with Takotsubo Cardiomyopathy

et al. 2014

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In this report, we introduce a case of thickening of the involved left ventricular apical segment on echocardiography and deep T-wave inversions in precordial leads on electrocardiography transiently seen in the course of recovery from biventricular takotsubo cardiomyopathy, mimicking apical hypertrophic cardiomyopathy. This result suggests that the echocardiographic finding of transient myocardial edema can be identified by cardiac magnetic resonance imaging in takotsubo cardiomyopathy. Additionally, it persisted a few weeks after full functional recovery. We believe that this case will contribute in part toward clarifying the pathophysiology of takotsubo cardiomyopathy.

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Section: Discussionmentioning

confidence: 56%

Evolutionary Change Mimicking Apical Hypertrophic Cardiomyopathy in a Patient with Takotsubo Cardiomyopathy

et al. 2014

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“…Furthermore, right ventricular involvement was associated with poor clinical outcomes 91011. In the present case, concomitant right ventricular involvement of takotsubo cardiomyopathy resulted in a highly friable right ventricle susceptible to rupture by mechanical wall stress, acute increase of volume and pressure overload worsened by left to right shunt.…”

Section: Discussionmentioning

confidence: 58%

“…Although takotsubo cardiomyopathy commonly involves the left ventricle, recent studies have reported right ventricular involvement in 28% to 50% 91011. Furthermore, right ventricular involvement was associated with poor clinical outcomes 91011.…”

Section: Discussionmentioning

confidence: 99%

Rupture of Right Ventricular Free Wall Following Ventricular Septal Rupture in Takotsubo Cardiomyopathy with Right Ventricular Involvement

et al. 2017

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Most patients diagnosed with takotsubo cardiomyopathies are expected to almost completely recover, and their prognosis is excellent. However, complications can occur in the acute phase. We present a case of a woman with takotsubo cardiomyopathy with right ventricular involvement who developed a rupture of the right ventricular free wall following ventricular septal rupture, as a consequence of an acute increase in right ventricular afterload by left-to-right shunt. Our case report illustrates that takotsubo cardiomyopathy can be life threatening in the acute phase. Ventricular septal rupture in biventricular takotsubo cardiomyopathy may be a harbinger of cardiac tamponade by right ventricular rupture.

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“…The right ventricle (RV) is frequently involved in TTC. 3,4 In our series, approximately 30% of TTC patients had detectable RV involvement on transthoracic echocardiography. However, both echocardiographic and cardiac magnetic resonance imaging assessment suggested that in most cases this involvement was limited to apical hypokinesis rather than extensive RV dysfunction.…”

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confidence: 59%

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Chong¹,

Neil²,

Nguyen³

et al. 2013

Clinical Cardiology

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Authors Reply:We thank Dr. Yalcinkaya and his colleagues for their interest in our analysis of factors underlying the development of hypotension and shock in takotsubo cardiomyopathy (TTC).1 When designing our evaluation, we were initially conscious of the potential interactions of changes within the myocardium (inflammation and regional negative inotropy), potential mechanical issues (outflow tract obstruction, mitral regurgitation, and possibly diastolic ventricular interaction), and disparate peripheral vasomotor stimuli (catecholamine and brain natriuretic peptide release). Our conclusion was that the development of hypotension/shock reflected complex interactions among these factors, rather than easily identifiable individual parameters. Furthermore, it might also be argued that the balance between β1-to β2-adrenoceptor stimulation in individual patients might also be relevant. The right ventricle (RV) is frequently involved in TTC. 3,4 In our series, approximately 30% of TTC patients had detectable RV involvement on transthoracic echocardiography. However, both echocardiographic and cardiac magnetic resonance imaging assessment suggested that in most cases this involvement was limited to apical hypokinesis rather than extensive RV dysfunction. In the minority of patients with more extensive (echocardiographic) RV dysfunction, no multivariate correlation with hypotension emerged. It is, of course, possible that in some cases echocardiography was performed after hemodynamic status had improved, so we agree that we may have underestimated the role of RV involvement (assuming that the RV recovers rapidly). We also agree that in theory, TTC is likely to involve the whole RV in an acute inflammatory process. 5 We also agree that there is a case for the utilization of T1 mapping in detection of myocardial edema. However, our methodology utilizing T2-weighted signal ratio was relatively reproducible and permitted quantitation of extent of overall left ventricular edema. 5 Detection per se of edema was not a relevant issue here. However, in the context of Dr. Yalcinkaya's interest in the RV, it would indeed be desirable for such methodology to be applicable to both ventricles.

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Right Ventricular Abnormalities in Takotsubo Cardiomyopathy

Abstract: RV contractile abnormalities may follow the same LV regional distribution in Takotsubo cardiomyopathy; the type of presentation rather than the presence of RV dysfunction seems to be responsible for an increased risk of complications and severity of functional impairment.

Cited by 16 publications

References 14 publications

Evolutionary Change Mimicking Apical Hypertrophic Cardiomyopathy in a Patient with Takotsubo Cardiomyopathy

Evolutionary Change Mimicking Apical Hypertrophic Cardiomyopathy in a Patient with Takotsubo Cardiomyopathy

Rupture of Right Ventricular Free Wall Following Ventricular Septal Rupture in Takotsubo Cardiomyopathy with Right Ventricular Involvement

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