Clinical implications of midventricular obstruction and intravenous propranolol use in transient left ventricular apical ballooning (Tako-tsubo cardiomyopathy).
BACKGROUND
Persistent hypotension with dynamic midventricular obstruction (MVO) in patients with transient left ventricular (LV) apical ballooning (Tako-tsubo cardiomyopathy) is an important complication that needs to be treated.


OBJECTIVE
The objective of this study is to determine the effects of intravenous propranolol challenge on MVO in transient LV apical ballooning.


METHODS
Thirty-four patients (12 males, 22 females, mean age 64 +/- 17 years, age range 22-84 years) with LV apical ballooning were enrolled. The hemodynamic and echocardiographic effects of propranolol (0.05 mg/kg, maximum 4 mg) were analyzed in 13 patients.


RESULTS
(1) Midventricular obstruction was present in 8 (24%) of 34 patients, and the pressure gradient (PG) ranged from 28 to 140 mm Hg. (2) Patients with MVO had similar demographic and clinical characteristics (symptoms, peak creatine kinase, plasma catecholamine levels) as those without MVO; however, in patients with MVO, abnormal Q waves on electrocardiogram and hypotension were more prevalent. (3) In the MVO group, intravenous propranolol changed the PG from 90 +/- 42 to 22 +/- 9 mm Hg, the systolic blood pressure (SBP) from 85 +/- 11 to 116 +/- 20 mm Hg, and the LV ejection fraction (LVEF) from 30% +/- 7% to 43% +/- 4%. (4) In all subjects, the changes in the PG after propranolol injection had a significant linear correlation with the SBP and LVEF changes: deltaSBP = 4.738 + 0.315 x deltaPG (r = 0.689 (P < .001) and deltaLVEF = 2.973 + 0.1321 x deltaPG (r = 0.715, P < .001).


CONCLUSIONS
Intravenous propranolol is useful for treating dynamic MVO in patients with transient LV apical ballooning.
Yoshioka
Takuji
T
Second Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan.
Hashimoto
Akiyoshi
A
Tsuchihashi
Kazufumi
K
Nagao
Kazuhiko
K
Kyuma
Michifumi
M
Ooiwa
Hitoshi
H
Nozawa
Akihiko
A
Shimoshige
Shinya
S
Eguchi
Mariko
M
Wakabayashi
Takeru
T
Yuda
Satoshi
S
Hase
Mamoru
M
Nakata
Tomoaki
T
Shimamoto
Kazuaki
K
D000319:Adrenergic beta-Antagonists / Q000008:administration & dosage*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D004305:Dose-Response Relationship, Drug; D004452:Echocardiography / Q000379:methods; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007275:Injections, Intravenous; D008297:Male; D008875:Middle Aged; D011433:Propranolol / Q000008:administration & dosage*; D013318:Stroke Volume / Q000502:physiology; D054549:Takotsubo Cardiomyopathy / Q000150:complications* / Q000188:drug therapy / Q000503:physiopathology; D014694:Ventricular Outflow Obstruction / Q000188:drug therapy* / Q000209:etiology / Q000503:physiopathology
D000319:Adrenergic beta-Antagonists; D011433:Propranolol