Impact of right ventricular involvement on the prognosis of takotsubo cardiomyopathy

• Published in: European heart journal cardiovascular imaging Vol. 17; no. 2; p. 210
• Main Authors: Kagiyama, Nobuyuki, Okura, Hiroyuki, Tamada, Tomoko, Imai, Koichiro, Yamada, Ryotaro, Kume, Teruyoshi, Hayashida, Akihiro, Neishi, Yoji, Kawamoto, Takahiro, Yoshida, Kiyoshi
• Format: Journal Article
• Language: English
• Published: England 01.02.2016
• Subjects: Aged; Echocardiography, Doppler - methods; Female; Hospital Mortality; Humans; Male; Patient Readmission - statistics & numerical data; Prognosis; Retrospective Studies; Takotsubo Cardiomyopathy - diagnostic imaging; Takotsubo Cardiomyopathy - mortality; Takotsubo Cardiomyopathy - physiopathology; Takotsubo Cardiomyopathy - therapy; Ventricular Dysfunction, Right - diagnostic imaging; Ventricular Dysfunction, Right - mortality; Ventricular Dysfunction, Right - physiopathology; Ventricular Dysfunction, Right - therapy; cardiomyopathy; prognosis; echocardiography
• ISSN: 2047-2412
• DOI: 10.1093/ehjci/jev145

Previous studies showed that patients with takotsubo cardiomyopathy had a higher long-term mortality rate than the general population and the incidence of in-hospital complications was higher in takotsubo cardiomyopathy with than without right ventricular (RV) involvement. This study was performed to investigate the long-term prognostic impact of RV involvement in takotsubo cardiomyopathy. The clinical data of 113 patients (72.7 ± 11.4 years old, 84 females) with takotsubo cardiomyopathy were studied retrospectively. The patients were divided into two groups according to the presence (biventricular group, n = 21, 18.6%) or absence (classical group, n = 92, 81.4%) of RV involvement assessed by initial echocardiography. The end point was a composite of all-cause death, re-hospitalization due to heart failure, and recurrence of takotsubo cardiomyopathy. The in-hospital mortality rate was significantly higher in the biventricular group than the classical group (14.3 vs. 1.1%, respectively, P = 0.02). Kaplan-Meier analysis indicated a significantly lower event-free survival rate in the biventricular group than the classical group (log-rank, P < 0.001). On multivariate analysis, RV involvement was the only independent predictor of the end point (HR: 2.73, P = 0.026). The rates of in-hospital and long-term events were significantly higher in takotsubo cardiomyopathy with than without RV involvement, and RV involvement was the independent predictor of the poor prognosis.