title: Prevalence and prognostic role of right ventricular involvement in stress-induced cardiomyopathy.
abstract: BACKGROUND
  Stress-induced cardiomyopathy (SCM) is a reversible cardiomyopathy observed in patients without significant coronary disease. The aim of this study was to assess the incidence and clinical significance of right ventricular (RV) involvement in SCM.
  
  
  RESULTS
  We retrospectively analyzed echocardiograms from 40 consecutive patients who presented with SCM at Stanford University Medical Center from September 2000 to November 2010. The primary end point was overall mortality. RV involvement was observed in 20 patients (50%; global RV hypokinesia in 15 patients and focal RV apical akinesia in 5 patients). The independent correlates of RV involvement were older age (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.02-1.7two, P = .01) and LVEF (per 10% decrease: OR 3.60, CI 1.77-7.32; P = .02). At a mean follow-up of 44 ± 32 months, 12 patients (30%) died (in-hospital death in 3 patients). At multivariate analysis, the presence of an RV fractional area change <35% emerged as an independent predictor of death (OR 3.6, CI 1.06-12.41; P = .04).
  
  
  CONCLUSIONS
  RV involvement is a common finding in SCM, and may present as either global or focal RV apical involvement. Both older age and lower LVEF are associated with a higher risk of RV involvement, which appears to be a major predictor of death.
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California; Department of Cardiovascular Sciences, St. George's University of London, London, England. Electronic address: gherardobis@yahoo.it.
authors.forename: Gherardo
authors.initials: G
authors.lastname: Finocchiaro
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Yukari
authors.initials: Y
authors.lastname: Kobayashi
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Emma
authors.initials: E
authors.lastname: Magavern
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Jessica Q
authors.initials: JQ
authors.lastname: Zhou
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California; Stanford Cardiovascular Institute, Palo Alto, California. Electronic address: euan@stanford.edu.
authors.forename: Euan
authors.initials: E
authors.lastname: Ashley
authors.affiliation: Cardiovascular Department, Ospedali Riuniti and University of Trieste, Trieste, Italy.
authors.forename: Gianfranco
authors.initials: G
authors.lastname: Sinagra
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Ingela
authors.initials: I
authors.lastname: Schnittger
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California; Stanford Cardiovascular Institute, Palo Alto, California.
authors.forename: Joshua W
authors.initials: JW
authors.lastname: Knowles
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California.
authors.forename: William F
authors.initials: WF
authors.lastname: Fearon
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California; Stanford Cardiovascular Institute, Palo Alto, California.
authors.forename: Francois
authors.initials: F
authors.lastname: Haddad
authors.affiliation: Division of Cardiovascular Medicine, Department of Medicine, Stanford University School of Medicine, Palo Alto, California.
authors.forename: Jennifer A
authors.initials: JA
authors.lastname: Tremmel
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D011379:Prognosis; D012189:Retrospective Studies; D013318:Stroke Volume / Q000502:physiology; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology; D018497:Ventricular Dysfunction, Right / Q000175:diagnosis* / Q000453:epidemiology* / Q000503:physiopathology
keywords: Stress cardiomyopathy; echocardiography; right ventricle