title: Right Ventricular Involvement and Recovery After Acute Stress-Induced (Tako-tsubo) Cardiomyopathy.
abstract: Acute stress-induced (Tako-tsubo) cardiomyopathy is an increasingly recognized but insufficiently characterized syndrome. Here, we investigate the pathophysiology of right ventricular (RV) involvement in Tako-tsubo and its recovery time course. We prospectively recruited 31 patients with Tako-tsubo with predominantly ST-elevation electrocardiogram and 18 controls of similar gender, age, and co-morbidity distribution. Patients underwent echocardiography and cardiac magnetic resonance (CMR) imaging on a 3T Philips scanner in the acute phase (day 0 to 3 after presentation) and at 4-months follow-up. Visually, echocardiography was able to identify only 52% of patients who showed RV wall motion abnormalities on CMR. Only CMR-derived RV ejection fraction (p = 0.01) and echocardiography-estimated pulmonary artery pressure (p = 0.01) identify RV functional involvement in the acute phase. Although RV ejection fraction normalizes in most patients by 4 months, acutely there is RV myocardial edema in both functioning and malfunctioning segments, as measured by prolonged native T1 mapping (p = 0.02 for both vs controls), and this persists at 4 months in the acutely malfunctioning segments (p = 0.002 vs controls). The extracellular volume fraction was significantly increased acutely in all RV segments and remained increased at follow-up compared with controls (p = 0.004 for all). In conclusion, in a Tako-tsubo population presenting predominantly with ST-elevation electrocardiogram, we demonstrate that although RV functional involvement is seen in only half of the patients, RV myocardial edema is present acutely throughout the RV myocardium in all patients and results in microscopic fibrosis at 4-month follow-up.
authors.affiliation: School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Caroline
authors.initials: C
authors.lastname: Scally
authors.affiliation: School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Trevor
authors.initials: T
authors.lastname: Ahearn
authors.affiliation: School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Amelia
authors.initials: A
authors.lastname: Rudd
authors.affiliation: The Queen Elizabeth Hospital, Adelaide, Australia.
authors.forename: Christopher J
authors.initials: CJ
authors.lastname: Neil
authors.affiliation: School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Janaki
authors.initials: J
authors.lastname: Srivanasan
authors.affiliation: School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Baljit
authors.initials: B
authors.lastname: Jagpal
authors.affiliation: The Queen Elizabeth Hospital, Adelaide, Australia.
authors.forename: John
authors.initials: J
authors.lastname: Horowitz
authors.affiliation: School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom.
authors.forename: Michael
authors.initials: M
authors.lastname: Frenneaux
authors.affiliation: School of Medicine and Dentistry, University of Aberdeen, Aberdeen, United Kingdom. Electronic address: dana.dawson@abdn.ac.uk.
authors.forename: Dana K
authors.initials: DK
authors.lastname: Dawson
mesh_terms: D000208:Acute Disease; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D018450:Disease Progression; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000503:physiopathology*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D020127:Recovery of Function / Q000502:physiology*; D013315:Stress, Psychological / Q000150:complications*; D013318:Stroke Volume / Q000502:physiology; D013577:Syndrome; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis / Q000209:etiology / Q000503:physiopathology*; D016278:Ventricular Function, Right / Q000502:physiology*