Volume 17 Supplement 1

Abstracts of the 18th Annual SCMR Scientific Sessions

Open Access

Right ventricular involvement in Tako-tsubo cardiomyopathy - insights from cardiovascular magnetic resonance

  • Caroline Scally1,
  • Christopher J Neil1,
  • Janaki Srinivasan1,
  • Baljit Jagpal1,
  • Bernice K Ng1,
  • Michael P Frenneaux1,
  • John Horowitz1 and
  • Dana K Dawson1
Journal of Cardiovascular Magnetic Resonance201517(Suppl 1):P280

https://doi.org/10.1186/1532-429X-17-S1-P280

Published: 3 February 2015

Background

It has been recently suggested that patients with Tako-tsubo cardiomyopathy (TTC) who exhibit right ventricular (RV) involvement at Echocardiography may have a worse prognosis. The aim of the current study was to prospectively evaluate the extent of RV involvement acutely and at follow up using gold-standard cardiac magnetic resonance (CMR).

Methods

21 patients, mean age 66 (range 41-87 years) with a clear diagnosis of TTC (14 with ST-elevation, 16 with apical ballooning ) and emotional trigger were prospectively studied. CMR-derived LV and RV volumes and EF, RV shapes, RV wall motion index (WMSI, 6-segment model) and Echocardiography derived Pulmonary artery pressure (Pap), tricuspid annular E',A',S', pansystolic excursion (TAPSE) were measured acutely (day 0-3) and after 4 months follow-up.

Results

Eleven patients demonstrated RV involvement on CMR - in contrast, RV wall motion abnormalities were identified in only 6 patients on Echocardiography Patients were grouped according to the "acute" RV-WMSI on CMR: WMSI=1 (Group A, n=10) and WMSI>1 (Group B, n=11).

In the acute phase, LVEF was significantly lower in Group B compared with Group A (48±10% vs 62±6%, p=0.02), but this did not reach statistical significance for RVEF (58±13% vs 65±7%, p=ns). However, Pap was significantly higher acutely in Group B compared to Group A (40±15 mmHg vs 28±6 mmHg, p=0.04). There were no significant differences between Groups for RV volumes (raw and indexed), E', A', S' or TAPSE.

At follow-up, LVEF improved significantly in both groups (62±6% to 66±6% in Group A, p= 0.01 and 48±10% to 63±6% in Group B, p<0.01). Pap decreased significantly in Group B (from 40±15 to 28±8, p=0.018). RV-WMSI normalized in all but one in Group B.

Conclusions

CMR detected RV involvement in 52% of patients presenting with acute TTC vs only 29% detected on Echocardiography and should be used as a gold-standard. WMSI and Pap are the best markers to identify these patients.

Funding

Grant:G13/10 from Tenovus Scotland.

Authors’ Affiliations

(1)
Cardiology, University of Aberdeen

Copyright

© Scally et al; licensee BioMed Central Ltd. 2015

This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

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