Prevalence, associated factors and management implications of left ventricular outflow tract obstruction in takotsubo cardiomyopathy: a two-year, two-center experience

BMC Cardiovascular Disorders

Research Article

Luc Muyldermans¹  Philippe Debonnaire¹  Luc Missault¹  Sofie Gevaert²  Peter Gheeraert²  Ole De Backer³ 

[1] Department of Cardiology, AZ Sint-Jan Hospital, Bruges, Belgium;Department of Cardiology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium;Department of Cardiology, Ghent University Hospital, De Pintelaan 185, B-9000, Ghent, Belgium;Department of Cardiology, AZ Sint-Jan Hospital, Bruges, Belgium;

关键词: Takotsubo cardiomyopathy;    Apical ballooning;    Outflow tract obstruction;    Systolic anterior motion;    Cardiogenic shock;   

DOI  :  10.1186/1471-2261-14-147

 received in 2014-08-04, accepted in 2014-10-17,  发布年份 2014

来源: Springer

【 摘 要 】

BackgroundSome patients with Takotsubo cardiomyopathy (TTC) develop cardiogenic shock due to left ventricular outflow tract (LVOT) obstruction – there is, however, a paucity of data regarding this condition.MethodsPrevalence, associated factors and management implications of LVOT obstruction in TTC was explored, based on two-year data from two Belgian heart centres.ResultsA total of 32 patients with TTC were identified out of 3,272 patients presenting with troponin-positive acute coronary syndrome. In six patients diagnosed with TTC (19%), a significant LVOT obstruction was detected by transthoracic echocardiography. Patients with LVOT obstruction were older and had more often septal bulging, and presented more frequently in cardiogenic shock as compared to those without LVOT obstruction (P < 0.05). Moreover, all patients with LVOT obstruction showed systolic anterior motion (SAM) of the anterior mitral valve leaflet, which was associated with a higher grade of mitral regurgitation (2.2±0.7 vs. 1.0±0.6, P<0.001). Adequate therapeutic management including fluid resuscitation, cessation of inotropic therapy, intravenous β-blocker, and the use of intra-aortic balloon pump resulted in non-inferior survival in TTC patients with LVOT obstruction as compared to those without LVOT obstruction.ConclusionsTTC is complicated by LVOT obstruction in approximately 20% of cases. Older age, septal bulging, SAM-induced mitral regurgitation and hemodynamic instability are associated with this condition. Timely and accurate diagnosis of LVOT obstruction by echocardiography is key to successful management of these TTC patients with LVOT obstruction and results in a non-inferior outcome as compared to those patients without LVOT obstruction.

【 授权许可】

CC BY   
© De Backer et al.; licensee BioMed Central Ltd. 2014