title: Determinants of Secondary Pulmonary Hypertension in Patients with Takotsubo Cardiomyopathy.
abstract: BACKGROUND
  Although takotsubo cardiomyopathy (TTC) has been reported to have a favorable outcome, many complications may occur in the acute phase. Heart failure is the most common clinical complication in patients with TTC. We aimed to investigate determinants of secondary pulmonary hypertension (PH) in patients with TTC.
  
  
  METHODS
  This study consisted of 55 patients with TTC. Detailed echocardiographic measurements were taken, including pulmonary artery systolic pressure (PASP). PH was identified PASP >35 mmHg. The severity of mitral regurgitation (MR) was evaluated by measuring effective regurgitant orifice area (EROA). Follow-up echocardiography was performed in 45 patients (81.8%) within 4 weeks after initial presentation.
  
  
  RESULTS
  All patients were stratified into PH or no PH (NPH) group (average PASP: 46.2 ± 6.7 vs. 29.8 ± 3.3 mmHg, P < 0.001); 25 patients (45.5%) were categorized into the PH group. Left ventricular (LV) volume, LV ejection fraction, and troponin I levels did not significantly differ between the two groups. Age and EROA were significantly greater in PH group than NPH group (age; 74.6 ± 9.1 vs. 63.5 ± 17.7, EROA; 0.22 ± 0.17 vs. 0.03 ± 0.05 cm(2) , all P < 0.01). The multivariate analysis revealed that age and EROA were independent predictors for PH in patients with TTC (all P < 0.001). PASP was significantly improved at follow-up compared to those at initial presentation (35.8 ± 8.4 vs. 30.3 ± 7.9 mmHg, P < 0.01).
  
  
  CONCLUSIONS
  Age and the severity of MR were independent predictors for secondary PH in patients with TTC.
authors.affiliation: The Heart Institute at Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Masaki
authors.initials: M
authors.lastname: Izumo
authors.affiliation: Stanford University Medical Center, Stanford, California.
authors.forename: Maiko
authors.initials: M
authors.lastname: Shiota
authors.affiliation: The Heart Institute at Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Smruti
authors.initials: S
authors.lastname: Nalawadi
authors.affiliation: The Heart Institute at Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Jayanta
authors.initials: J
authors.lastname: Das
authors.affiliation: The Heart Institute at Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Sohail
authors.initials: S
authors.lastname: Dohad
authors.affiliation: The Heart Institute at Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Eiji
authors.initials: E
authors.lastname: Kuwahara
authors.affiliation: The Heart Institute at Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Yoko
authors.initials: Y
authors.lastname: Fukuoka
authors.affiliation: The Heart Institute at Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Robert J
authors.initials: RJ
authors.lastname: Siegel
authors.affiliation: The Heart Institute at Cedars-Sinai Medical Center, Los Angeles, California.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Shiota
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015150:Echocardiography, Doppler; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D006976:Hypertension, Pulmonary / Q000150:complications* / Q000000981:diagnostic imaging*; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000150:complications / Q000000981:diagnostic imaging; D011651:Pulmonary Artery / Q000000981:diagnostic imaging; D012720:Severity of Illness Index; D054549:Takotsubo Cardiomyopathy / Q000150:complications* / Q000000981:diagnostic imaging*
keywords: echocardiography; pulmonary hypertension; takotsubo cardiomyopathy