Right ventricular involvement in Takotsubo cardiomyopathy

• Published in: European heart journal Vol. 27; no. 20; pp. 2433 - 2439
• Main Authors: HAGHI, Dariusch, ATHANASIADIS, Anastasios, PAPAVASSILIU, Theano, SUSELBECK, Tim, FLUECHTER, Stephan, MAHRHOLDT, Heiko, BORGGREFE, Martin, SECHTEM, Udo
• Format: Journal Article
• Language: English
• Published: Oxford Oxford University Press 01-10-2006; Oxford Publishing Limited (England)
• Subjects: Aged; Aged, 80 and over; Biological and medical sciences; Cardiac Catheterization; Cardiology. Vascular system; Cardiomyopathies - complications; Coronary Angiography; Female; Heart; Humans; Magnetic Resonance Angiography; Male; Medical sciences; Myocarditis. Cardiomyopathies; Prospective Studies; Retrospective Studies; Stroke Volume - physiology; Ventricular Dysfunction, Right - diagnosis; Ventricular Dysfunction, Right - etiology; Cardiomyopathy; Heart disease; Right ventricle; Cardiovascular disease; Takotsubo cardiomyopathy; Circulatory system; Cardiology; Apical ballooning syndrome; Myocardial disease; Phlebology; Syndrome
• ISSN: 0195-668X; 1522-9645
• DOI: 10.1093/eurheartj/ehl274

The aim of our study is to assess the incidence and clinical significance of right ventricular (RV) involvement in Takotsubo cardiomyopathy (TTC).
Between February 2002 and December 2005, 47 patients with TTC underwent cardiovascular magnetic resonance (CMR) at our institutions. 13 patients with delayed initial CMR were excluded. In the remaining 34 patients (32 women), RV wall motion abnormalities (WMAs) were present in nine (26%). Left ventricular ejection fraction (LVEF) was significantly lower in patients with RV involvement (40 +/- 6 vs. 48 +/- 10%, P = 0.04). The most frequently affected RV segments were the apico-lateral (89%), the antero-lateral (67%), and the inferior segment (67%). All RV WMA improved or disappeared in eight of nine patients who underwent a follow-up CMR study. Pleural effusion was more common in patients with RV involvement (67 vs. 8%, P < 0.001) and was predictive of RV dysfunction (sensitivity 67% and specificity 92%). Significant or bilateral pleural effusions were seen exclusively in patients with RV involvement.
RV involvement is common in TTC and seems to be associated with a more severe impairment in LV systolic function. It may be suspected by the presence of pleural effusion.