Documentation of early improvement of left ventricular function in tako-tsubo cardiomyopathy

Abstract

Reply We appreciate the comments and suggestions of Dr. Nef regarding our report. Previous reports have demonstrated that left ventricular function return to normal after 8 to 53 days after the onset of tako-tsubo cardiomyopathy [1]. Apical ballooning immediately after the onset can be evaluated with transthoracic echocardiography, to be sure, but the evaluation of its normalization is more difficult unexpectedly. Left ventriculography is more invasive, but more objective than transthoracic echocardiography to evaluate left ventricular function. I think that our report is precious because it has been first demonstrated that left ventricular function can return to normal within only 41 h with serial left ventriculogram which is an objective examination [2]. Previous studies have demonstrated various complications of tako-tsubo cardiomyopathy including congestive heart failure, cardiogenic shock, apical thrombus formation, ventricular free wall rupture, ventricular septal perforation and malignant arrhythmia [3]. I think that the earlier left ventricular function improves the less frequently at least congestive heart failure, cardiogenic shock and apical thrombus formation are likely to occur. The occurrence of arrhythmia is often associated with other factors such as QT interval prolongation or autonomic imbalance, and it may be unlikely that the time period until recovery is a suitable predictor for arrhythmia. Furthermore, tako-tsubo cardiomyopathy often occurs in patients with critical condition. In these patients, clinical outcome is dependent on the triggering disease rather than tako-tsubo cardiomyopathy, and it may be unlikely that the time period until recovery is a suitable predictor for clinical outcome. I read with great interest Dr. Nef's preliminary data between NT-proBNP and clinical outcome. We have experienced more than 60 patients with tako-tsubo cardiomyopathy, and know that the size of apical ballooning is various during early phase. I wonder if the serum level of NT-proBNP is associated with the size of apical ballooning or the time period until recovery. I am looking forward to the published report. References