Systolic anterior motion of the mitral valve in tako-tsubo cardiomyopathy: Still a matter of debate?
We present a case which developed a typical tako-tsubo-like cardiomyopathy (TTC) during dobutamine stress echocardiography (DSE). Its originality is related to several findings, which have never been described simultaneously in the same patient. This 63-year-old woman with normal coronary angiography and no evidence of coronary vasospasm had a biphasic response to DSE, a finding which usually occurs in coronary artery disease. Moreover, the symmetric extensive wall motion abnormalities (WMA) occurred simultaneously with the development of a systolic anterior motion of the mitral valve (SAM) and left ventricular obstruction, and was clinically asymptomatic. Although in TTC the stunning usually occurs for several days, WMA and SAM resolved within few minutes after cessation of dobutamine and administration of a beta-blocker. And finally, exercise echo performed at the same target heart rate few days later did not induce neither a SAM nor WMA, which suggests that left ventricular obstruction could have played a role in the pathogenesis of this case by supply-demand mismatch. Concomitant coronary microvascular dysfunction was also demonstrated by a reduction of the non-invasive coronary flow reserve in the distal part of the left anterior descending artery.
Department of Cardiology and Intensive Care Unit, centre hospitalier de Compiègne, 8, rue Henri-Adnot, 60200 Compiègne, France. Electronic address: patrickmeimoun.md@gmail.com.
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Meimoun
Department of Cardiology and Intensive Care Unit, centre hospitalier de Compiègne, 8, rue Henri-Adnot, 60200 Compiègne, France.
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J
Clerc
Department of Cardiology and Intensive Care Unit, centre hospitalier de Compiègne, 8, rue Henri-Adnot, 60200 Compiègne, France.
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Botoro
Department of Cardiology and Intensive Care Unit, centre hospitalier de Compiègne, 8, rue Henri-Adnot, 60200 Compiègne, France.
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Elmkies
Department of Cardiology and Intensive Care Unit, centre hospitalier de Compiègne, 8, rue Henri-Adnot, 60200 Compiègne, France.
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Martis
Department of Cardiology and Intensive Care Unit, centre hospitalier de Compiègne, 8, rue Henri-Adnot, 60200 Compiègne, France.
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Zemir
Department of Cardiology and Intensive Care Unit, centre hospitalier de Compiègne, 8, rue Henri-Adnot, 60200 Compiègne, France.
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Luycx-Bore
D025401:Echocardiography, Stress; D005260:Female; D006801:Humans; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging / Q000503:physiopathology*; D013599:Systole; D054549:Takotsubo Cardiomyopathy / Q000000981:diagnostic imaging / Q000503:physiopathology*
Cardiomyopathie de tako-tsubo; Coronary flow reserve; Left ventricular obstruction; Mouvement systolique antérieur de la valve mitrale; Obstruction intra-ventriculaire gauche; Réserve de flux coronaire; Systolic anterior motion of the mitral valve; Tako-tsubo cardiomyopathy