Dissociation of Early Shock in Takotsubo Cardiomyopathy from either Right or Left Ventricular Systolic Dysfunction

Kuljit Singh, Christopher J Neil, Thanh Ha Nguyen, Jeanette Stansborough, Cher-Rin Chong, Dana Dawson, Michael P Frenneaux, John D Horowitz

Research output: Contribution to journalArticle

12 Citations (Scopus)

Abstract

BACKGROUND: Takotsubo cardiomyopathy (TTC) is often associated with hypotension and shock. However, development of hypotension/shock in TTC is not closely related to extent of left ventricular (LV) hypokinesis. We sought to determine whether additional right ventricular (RV) involvement in TTC might contribute to hypotension and shock development and thus to prolonged hospital stay (PHS).

METHODS: We evaluated 102 consecutive TTC patients with acute transthoracic echocardiography (TTE) to detect RV hypokinesis. Correlates of hypotension, shock and PHS were identified by univariate and multivariate analyses.

RESULTS: Of the 102 patients evaluated, 33% had RV hypokinesis but only 9% had extensive RV involvement. Within the first 24hours of admission, severe hypotension (systolic blood pressure (SBP) ≤ 90mmHg) occurred in 21% of the patients and shock (hypotension + peripheral organ hypo-perfusion) in 16.6% of cases. RV involvement was a univariate but not a multivariate correlate of either hypotension or shock and did not result in PHS. On the other hand, RV involvement predicted more extensive LV hypokinesis and LV systolic dysfunction.

CONCLUSIONS: In TTC, RV hypokinesis occurs in approximately 33% of cases and correlates with more severe LV wall motion abnormality but not with development of hypotension or shock. These data therefore reinforce previous findings that hypotension/shock in TTC are not purely by impaired cardiac output.

Original languageEnglish
Pages (from-to)1141-1148
Number of pages8
JournalHeart, Lung and Circulation
Volume23
Issue number12
Early online date27 Jun 2014
DOIs
Publication statusPublished - Dec 2014

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Takotsubo Cardiomyopathy
Left Ventricular Dysfunction
Hypotension
Shock
Length of Stay
Blood Pressure
Cardiac Output
Echocardiography
Multivariate Analysis
Perfusion

Keywords

  • Takotsubo cardiomyopathy
  • right ventricle
  • hypotension
  • shock
  • stress cardiomyopathy

Cite this

Dissociation of Early Shock in Takotsubo Cardiomyopathy from either Right or Left Ventricular Systolic Dysfunction. / Singh, Kuljit; Neil, Christopher J; Nguyen, Thanh Ha; Stansborough, Jeanette; Chong, Cher-Rin; Dawson, Dana; Frenneaux, Michael P; Horowitz, John D.

In: Heart, Lung and Circulation, Vol. 23, No. 12, 12.2014, p. 1141-1148.

Research output: Contribution to journalArticle

Singh, K, Neil, CJ, Nguyen, TH, Stansborough, J, Chong, C-R, Dawson, D, Frenneaux, MP & Horowitz, JD 2014, 'Dissociation of Early Shock in Takotsubo Cardiomyopathy from either Right or Left Ventricular Systolic Dysfunction', Heart, Lung and Circulation, vol. 23, no. 12, pp. 1141-1148. https://doi.org/10.1016/j.hlc.2014.06.010
Singh, Kuljit ; Neil, Christopher J ; Nguyen, Thanh Ha ; Stansborough, Jeanette ; Chong, Cher-Rin ; Dawson, Dana ; Frenneaux, Michael P ; Horowitz, John D. / Dissociation of Early Shock in Takotsubo Cardiomyopathy from either Right or Left Ventricular Systolic Dysfunction. In: Heart, Lung and Circulation. 2014 ; Vol. 23, No. 12. pp. 1141-1148.
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abstract = "BACKGROUND: Takotsubo cardiomyopathy (TTC) is often associated with hypotension and shock. However, development of hypotension/shock in TTC is not closely related to extent of left ventricular (LV) hypokinesis. We sought to determine whether additional right ventricular (RV) involvement in TTC might contribute to hypotension and shock development and thus to prolonged hospital stay (PHS).METHODS: We evaluated 102 consecutive TTC patients with acute transthoracic echocardiography (TTE) to detect RV hypokinesis. Correlates of hypotension, shock and PHS were identified by univariate and multivariate analyses.RESULTS: Of the 102 patients evaluated, 33{\%} had RV hypokinesis but only 9{\%} had extensive RV involvement. Within the first 24hours of admission, severe hypotension (systolic blood pressure (SBP) ≤ 90mmHg) occurred in 21{\%} of the patients and shock (hypotension + peripheral organ hypo-perfusion) in 16.6{\%} of cases. RV involvement was a univariate but not a multivariate correlate of either hypotension or shock and did not result in PHS. On the other hand, RV involvement predicted more extensive LV hypokinesis and LV systolic dysfunction.CONCLUSIONS: In TTC, RV hypokinesis occurs in approximately 33{\%} of cases and correlates with more severe LV wall motion abnormality but not with development of hypotension or shock. These data therefore reinforce previous findings that hypotension/shock in TTC are not purely by impaired cardiac output.",
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T1 - Dissociation of Early Shock in Takotsubo Cardiomyopathy from either Right or Left Ventricular Systolic Dysfunction

AU - Singh, Kuljit

AU - Neil, Christopher J

AU - Nguyen, Thanh Ha

AU - Stansborough, Jeanette

AU - Chong, Cher-Rin

AU - Dawson, Dana

AU - Frenneaux, Michael P

AU - Horowitz, John D

N1 - Copyright © 2014 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.

PY - 2014/12

Y1 - 2014/12

N2 - BACKGROUND: Takotsubo cardiomyopathy (TTC) is often associated with hypotension and shock. However, development of hypotension/shock in TTC is not closely related to extent of left ventricular (LV) hypokinesis. We sought to determine whether additional right ventricular (RV) involvement in TTC might contribute to hypotension and shock development and thus to prolonged hospital stay (PHS).METHODS: We evaluated 102 consecutive TTC patients with acute transthoracic echocardiography (TTE) to detect RV hypokinesis. Correlates of hypotension, shock and PHS were identified by univariate and multivariate analyses.RESULTS: Of the 102 patients evaluated, 33% had RV hypokinesis but only 9% had extensive RV involvement. Within the first 24hours of admission, severe hypotension (systolic blood pressure (SBP) ≤ 90mmHg) occurred in 21% of the patients and shock (hypotension + peripheral organ hypo-perfusion) in 16.6% of cases. RV involvement was a univariate but not a multivariate correlate of either hypotension or shock and did not result in PHS. On the other hand, RV involvement predicted more extensive LV hypokinesis and LV systolic dysfunction.CONCLUSIONS: In TTC, RV hypokinesis occurs in approximately 33% of cases and correlates with more severe LV wall motion abnormality but not with development of hypotension or shock. These data therefore reinforce previous findings that hypotension/shock in TTC are not purely by impaired cardiac output.

AB - BACKGROUND: Takotsubo cardiomyopathy (TTC) is often associated with hypotension and shock. However, development of hypotension/shock in TTC is not closely related to extent of left ventricular (LV) hypokinesis. We sought to determine whether additional right ventricular (RV) involvement in TTC might contribute to hypotension and shock development and thus to prolonged hospital stay (PHS).METHODS: We evaluated 102 consecutive TTC patients with acute transthoracic echocardiography (TTE) to detect RV hypokinesis. Correlates of hypotension, shock and PHS were identified by univariate and multivariate analyses.RESULTS: Of the 102 patients evaluated, 33% had RV hypokinesis but only 9% had extensive RV involvement. Within the first 24hours of admission, severe hypotension (systolic blood pressure (SBP) ≤ 90mmHg) occurred in 21% of the patients and shock (hypotension + peripheral organ hypo-perfusion) in 16.6% of cases. RV involvement was a univariate but not a multivariate correlate of either hypotension or shock and did not result in PHS. On the other hand, RV involvement predicted more extensive LV hypokinesis and LV systolic dysfunction.CONCLUSIONS: In TTC, RV hypokinesis occurs in approximately 33% of cases and correlates with more severe LV wall motion abnormality but not with development of hypotension or shock. These data therefore reinforce previous findings that hypotension/shock in TTC are not purely by impaired cardiac output.

KW - Takotsubo cardiomyopathy

KW - right ventricle

KW - hypotension

KW - shock

KW - stress cardiomyopathy

U2 - 10.1016/j.hlc.2014.06.010

DO - 10.1016/j.hlc.2014.06.010

M3 - Article

VL - 23

SP - 1141

EP - 1148

JO - Heart, Lung and Circulation

JF - Heart, Lung and Circulation

SN - 1443-9506

IS - 12

ER -