title: Dissociation of early shock in takotsubo cardiomyopathy from either right or left ventricular systolic dysfunction.
abstract: BACKGROUND
  Takotsubo cardiomyopathy (TTC) is often associated with hypotension and shock. However, development of hypotension/shock in TTC is not closely related to extent of left ventricular (LV) hypokinesis. We sought to determine whether additional right ventricular (RV) involvement in TTC might contribute to hypotension and shock development and thus to prolonged hospital stay (PHS).
  
  
  METHODS
  We evaluated 102 consecutive TTC patients with acute transthoracic echocardiography (TTE) to detect RV hypokinesis. Correlates of hypotension, shock and PHS were identified by univariate and multivariate analyses.
  
  
  RESULTS
  Of the 102 patients evaluated, 33% had RV hypokinesis but only 9% had extensive RV involvement. Within the first 24 hours of admission, severe hypotension (systolic blood pressure (SBP) ≤ 90 mmHg) occurred in 21% of the patients and shock (hypotension + peripheral organ hypo-perfusion) in 16.6% of cases. RV involvement was a univariate but not a multivariate correlate of either hypotension or shock and did not result in PHS. On the other hand, RV involvement predicted more extensive LV hypokinesis and LV systolic dysfunction.
  
  
  CONCLUSIONS
  In TTC, RV hypokinesis occurs in approximately 33% of cases and correlates with more severe LV wall motion abnormality but not with development of hypotension or shock. These data therefore reinforce previous findings that hypotension/shock in TTC are not purely by impaired cardiac output.
authors.affiliation: Department of Cardiology, Queen Elizabeth Hospital, Adelaide, Australia. Electronic address: kjaulakh@gmail.com.
authors.forename: Kuljit
authors.initials: K
authors.lastname: Singh
authors.affiliation: Department of Medicine, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Neil
authors.affiliation: Department of Cardiology, Queen Elizabeth Hospital, Adelaide, Australia.
authors.forename: Thanh Ha
authors.initials: TH
authors.lastname: Nguyen
authors.affiliation: Department of Cardiology, Queen Elizabeth Hospital, Adelaide, Australia.
authors.forename: Jeanette
authors.initials: J
authors.lastname: Stansborough
authors.affiliation: Department of Cardiology, Queen Elizabeth Hospital, Adelaide, Australia.
authors.forename: Cher-Rin
authors.initials: CR
authors.lastname: Chong
authors.affiliation: Department of Medicine, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Dana
authors.initials: D
authors.lastname: Dawson
authors.affiliation: Department of Medicine, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Michael P
authors.initials: MP
authors.lastname: Frenneaux
authors.affiliation: Department of Cardiology, Queen Elizabeth Hospital, Adelaide, Australia.
authors.forename: John D
authors.initials: JD
authors.lastname: Horowitz
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001794:Blood Pressure; D004452:Echocardiography; D005260:Female; D006801:Humans; D007022:Hypotension / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D008297:Male; D008875:Middle Aged; D012770:Shock, Cardiogenic / Q000000981:diagnostic imaging / Q000209:etiology / Q000503:physiopathology; D054549:Takotsubo Cardiomyopathy / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000150:complications / Q000000981:diagnostic imaging / Q000503:physiopathology
keywords: Hypotension; Right ventricle; Shock; Stress cardiomyopathy; Takotsubo cardiomyopathy