title: Right ventricular abnormalities in Takotsubo cardiomyopathy.
abstract: BACKGROUND
  Takotsubo cardiomyopathy, described as transient regional contractile abnormalities limited to the apical and mid-segments of the left ventricle (LV), has also been reported to involve basal and/or mid LV segments (inverted Takotsubo); fewer reports, however, have addressed right ventricular (RV) dysfunction.
  
  
  OBJECTIVE
  To assess the distribution of regional abnormalities and RV involvement in Takotsubo cardiomyopathy and compare it to the literature.
  
  
  RESULTS
  We evaluated 23 patients with both classical and inverted presentations (19 female, aged 64 ± 19 years), including 2 recurrences, totaling 25 episodes. Classical Takotsubo was observed in 15 patients, while 10 had the inverted form. LV ejection fraction (EF) was lower for classical compared to inverted presentation (30 ± 7 vs. 45 ± 4%, P < 0.001) with higher troponin values (1.3 ± 1.4 vs. 0.5 ± 0.6, P = 0.034). RV abnormalities were found in 7 patients (28%), mainly with classical presentation (6 patients), presenting with mid and apical RV impairment. One patient with inverted Takotsubo had mid-RV involvement. Patients with RV involvement had lower left ventricular ejection fraction (LVEF) (28 ± 10% vs. 40 ± 10%, P = 0.02), but not when adjusted for presentation type. Overall rate of complications was higher for classical compared to inverted presentation, and not influenced by RV involvement.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Echocardiography Laboratory - MDP, Hospital Israelita Albert Einstein, Sao Paulo, Brazil.
authors.forename: Ana Clara
authors.initials: AC
authors.lastname: Rodrigues
authors.forename: Laise
authors.initials: L
authors.lastname: Guimaraes
authors.forename: Edgar
authors.initials: E
authors.lastname: Lira
authors.forename: Wercules
authors.initials: W
authors.lastname: Oliveira
authors.forename: Claudia
authors.initials: C
authors.lastname: Monaco
authors.forename: Adriana
authors.initials: A
authors.lastname: Cordovil
authors.forename: Claudio H
authors.initials: CH
authors.lastname: Fischer
authors.forename: Marcelo
authors.initials: M
authors.lastname: Vieira
authors.forename: Samira
authors.initials: S
authors.lastname: Morhy
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D054549:Takotsubo Cardiomyopathy / Q000150:complications* / Q000000981:diagnostic imaging*; D018497:Ventricular Dysfunction, Right / Q000000981:diagnostic imaging* / Q000209:etiology*; D055815:Young Adult
keywords: Takotsubo; echocardiography; right ventricle