title: Incidence and patterns of cardiomyopathy in carbon monoxide-poisoned patients with myocardial injury.
abstract: OBJECTIVE
  Sustained myocardial injury is a significant predictor of mortality in carbon monoxide (CO) poisoning. There are few reports in the literature regarding the presence of CO-induced cardiomyopathy from early stages in the emergency department (ED). We prospectively investigated the early incidence of CO-induced cardiomyopathy and its patterns in patients with cardiomyopathy.
  
  
  METHODS
  During a 10-month period, transthoracic echocardiography (TTE) was performed in 43 consecutive patients with CO poisoning and myocardial injury, which was defined as elevated high-sensitive troponin I within 24 h after ED arrival. Measurements of left ventricular ejection fraction and wall motion abnormalities were performed to evaluate cardiac function. If a patient had CO-induced cardiomyopathy, we measured cardiac function at the time of patient admission, day 1, day 2, and once within seven days of hospitalization.
  
  
  RESULTS
  The incidence of cardiomyopathy was as high as 74.4% (32 of 43 patients) in CO-poisoned patients with myocardial injury based on initial ED results. Echocardiographic patterns included non-cardiomyopathy (25.6%), global dysfunction (51.2%), and Takotsubo-like cardiomyopathy (23.2%). Patients in the global dysfunction group had significantly more normalized cardiac dysfunction within 72 h than did those in the Takotsubo-like cardiomyopathy group (81.8% vs. 22.2%, p = 0.001).
  
  
  CONCLUSIONS
  Patients with CO poisoning and myocardial injury experienced cardiomyopathy, including reversible global dysfunction and a Takotsubo-like pattern. Investigation of cardiomyopathy needs to be considered in patients with CO poisoning and myocardial injury.
authors.affiliation: a Department of Emergency Medicine , Wonju College of Medicine, Yonsei University , Wonju , Republic of Korea ;
authors.forename: Yong Sung
authors.initials: YS
authors.lastname: Cha
authors.affiliation: a Department of Emergency Medicine , Wonju College of Medicine, Yonsei University , Wonju , Republic of Korea ;
authors.forename: Hyun
authors.initials: H
authors.lastname: Kim
authors.affiliation: a Department of Emergency Medicine , Wonju College of Medicine, Yonsei University , Wonju , Republic of Korea ;
authors.forename: Sung Oh
authors.initials: SO
authors.lastname: Hwang
authors.affiliation: b Division of Cardiology, Department of Internal Medicine , Wonju College of Medicine, Yonsei University , Wonju , Republic of Korea ;
authors.forename: Jang Young
authors.initials: JY
authors.lastname: Kim
authors.affiliation: c Department of Emergency Medicine , Wonju Medical Center , Wonju , Republic of Korea ;
authors.forename: Yun Kwon
authors.initials: YK
authors.lastname: Kim
authors.affiliation: d Institute of Lifestyle Medicine, Wonju College of Medicine, Yonsei University , Wonju , Republic of Korea.
authors.forename: Eun Hee
authors.initials: EH
authors.lastname: Choi
authors.affiliation: a Department of Emergency Medicine , Wonju College of Medicine, Yonsei University , Wonju , Republic of Korea ;
authors.forename: Oh Hyun
authors.initials: OH
authors.lastname: Kim
authors.affiliation: a Department of Emergency Medicine , Wonju College of Medicine, Yonsei University , Wonju , Republic of Korea ;
authors.forename: Hyung Il
authors.initials: HI
authors.lastname: Kim
authors.affiliation: a Department of Emergency Medicine , Wonju College of Medicine, Yonsei University , Wonju , Republic of Korea ;
authors.forename: Kyoung Chul
authors.initials: KC
authors.lastname: Cha
authors.affiliation: a Department of Emergency Medicine , Wonju College of Medicine, Yonsei University , Wonju , Republic of Korea ;
authors.forename: Kang Hyun
authors.initials: KH
authors.lastname: Lee
mesh_terms: D000328:Adult; D000368:Aged; D002249:Carbon Monoxide Poisoning / Q000150:complications*; D009202:Cardiomyopathies / Q000209:etiology*; D004452:Echocardiography; D004636:Emergency Service, Hospital; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D015994:Incidence; D008297:Male; D008875:Middle Aged; D017202:Myocardial Ischemia / Q000209:etiology; D009206:Myocardium / Q000473:pathology*; D011446:Prospective Studies; D012307:Risk Factors; D019210:Troponin I / Q000097:blood; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D019210:Troponin I
keywords: Carbon monoxide; cardiomyopathy; echocardiography; myocardial injury