Abstract
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.Electronic supplementary materialThe online version of this article (doi:10.1186/1471-2261-14-147) contains supplementary material, which is available to authorized users.
Highlights
Some patients with Takotsubo cardiomyopathy (TTC) develop cardiogenic shock due to left ventricular outflow tract (LVOT) obstruction – there is, a paucity of data regarding this condition
The diagnosis of TTC was based on the Mayo-criteria [5]: (1) transient hypokinesia, akinesia, or dyskinesia of the LV mid segments with or without apical involvement – regional wall motion abnormalities extend beyond a single epicardial distribution; (2) absence of obstructive coronary artery disease or angiographic evidence of acute plaque rupture; (3) new electrocardiographic abnormalities or elevated cardiac troponin; (4) absence of a pheochromocytoma, myocarditis or hypertrophic cardiomyopathy
Overall study population Out of 3,272 patients with troponin-positive acute coronary syndrome (ACS) referred for coronary angiography, a total of 32 patients were identified with TTC – indicating an overall prevalence of 1.0% (Figure 1)
Summary
Some patients with Takotsubo cardiomyopathy (TTC) develop cardiogenic shock due to left ventricular outflow tract (LVOT) obstruction – there is, a paucity of data regarding this condition. Takotsubo cardiomyopathy (TTC) – called apical ballooning syndrome – is an increasingly reported clinical entity characterized by transient severe systolic heart failure that mimics an acute myocardial infarction in the absence of obstructive coronary artery disease [1,2]. Some patients with TTC develop cardiogenic shock due to severe systolic dysfunction or left ventricular outflow tract (LVOT) obstruction. We explored the prevalence and characteristics of TTC in a population presenting with troponin-positive acute coronary syndrome (ACS) – with focus on LVOT obstruction and its management
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