Right Ventricular Involvement and Recovery after Acute Stress-Induced (Tako-tsubo) Cardiomyopathy

Caroline Scally; Trevor Ahearn; Amelia Rudd; Christopher J. Neil; Janaki Srivanasan; Baljit Jagpal; John Horowitz; Michael Frenneaux; Dana K. Dawson

doi:10.1016/j.amjcard.2015.11.057

Right Ventricular Involvement and Recovery after Acute Stress-Induced (Tako-tsubo) Cardiomyopathy

Caroline Scally, Trevor Ahearn, Amelia Rudd, Christopher J. Neil, Janaki Srivanasan, Baljit Jagpal, John Horowitz, Michael Frenneaux, Dana K. Dawson

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Abstract

Acute stress-induced (Tako-tsubo) cardiomyopathy is an increasingly recognized but insufficiently characterized syndrome. Here, we investigate the pathophysiology of right ventricular (RV) involvement in Tako-tsubo and its recovery time course. We prospectively recruited 31 patients with Tako-tsubo with predominantly ST-elevation electrocardiogram and 18 controls of similar gender, age, and co-morbidity distribution. Patients underwent echocardiography and cardiac magnetic resonance (CMR) imaging on a 3T Philips scanner in the acute phase (day 0 to 3 after presentation) and at 4-months follow-up. Visually, echocardiography was able to identify only 52% of patients who showed RV wall motion abnormalities on CMR. Only CMR-derived RV ejection fraction (p = 0.01) and echocardiography-estimated pulmonary artery pressure (p = 0.01) identify RV functional involvement in the acute phase. Although RV ejection fraction normalizes in most patients by 4 months, acutely there is RV myocardial edema in both functioning and malfunctioning segments, as measured by prolonged native T1 mapping (p = 0.02 for both vs controls), and this persists at 4 months in the acutely malfunctioning segments (p = 0.002 vs controls). The extracellular volume fraction was significantly increased acutely in all RV segments and remained increased at follow-up compared with controls (p = 0.004 for all). In conclusion, in a Tako-tsubo population presenting predominantly with ST-elevation electrocardiogram, we demonstrate that although RV functional involvement is seen in only half of the patients, RV myocardial edema is present acutely throughout the RV myocardium in all patients and results in microscopic fibrosis at 4-month follow-up.

Original language	English
Pages (from-to)	775-780
Number of pages	6
Journal	The American Journal of Cardiology
Volume	117
Issue number	5
Early online date	13 Dec 2015
DOIs	https://doi.org/10.1016/j.amjcard.2015.11.057
Publication status	Published - 1 Mar 2016

Bibliographical note

Acknowledgment: The authors would like to thank all National Health Service Consultant Colleagues at Aberdeen Royal Infirmary for help with prompt recruitment of these patients (Dr. M Metcalfe, MD, Dr. AD Stewart, MD, Dr. A
Hannah, MD, Dr. A Noman, MD, Dr. P Broadhurst, MD, Dr. D Hogg, MD, and Dr. D Garg, MD) and to Dr. Gordon Prescott, PhD for help and advice with the statistical
methods.

This work was supported by a Tenovus Scotland, Nice, France award to Dr. Dawson and presented in part at the Society for Cardiovascular Magnetic Resonance Imaging/EuroCMR 2015 Joint Scientific Sessions from February 5 2015 to February 7, 2015

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Dana Dawson
Person: Clinical Academic

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title = "Right Ventricular Involvement and Recovery after Acute Stress-Induced (Tako-tsubo) Cardiomyopathy",

abstract = "Acute stress-induced (Tako-tsubo) cardiomyopathy is an increasingly recognized but insufficiently characterized syndrome. Here, we investigate the pathophysiology of right ventricular (RV) involvement in Tako-tsubo and its recovery time course. We prospectively recruited 31 patients with Tako-tsubo with predominantly ST-elevation electrocardiogram and 18 controls of similar gender, age, and co-morbidity distribution. Patients underwent echocardiography and cardiac magnetic resonance (CMR) imaging on a 3T Philips scanner in the acute phase (day 0 to 3 after presentation) and at 4-months follow-up. Visually, echocardiography was able to identify only 52% of patients who showed RV wall motion abnormalities on CMR. Only CMR-derived RV ejection fraction (p = 0.01) and echocardiography-estimated pulmonary artery pressure (p = 0.01) identify RV functional involvement in the acute phase. Although RV ejection fraction normalizes in most patients by 4 months, acutely there is RV myocardial edema in both functioning and malfunctioning segments, as measured by prolonged native T1 mapping (p = 0.02 for both vs controls), and this persists at 4 months in the acutely malfunctioning segments (p = 0.002 vs controls). The extracellular volume fraction was significantly increased acutely in all RV segments and remained increased at follow-up compared with controls (p = 0.004 for all). In conclusion, in a Tako-tsubo population presenting predominantly with ST-elevation electrocardiogram, we demonstrate that although RV functional involvement is seen in only half of the patients, RV myocardial edema is present acutely throughout the RV myocardium in all patients and results in microscopic fibrosis at 4-month follow-up.",

author = "Caroline Scally and Trevor Ahearn and Amelia Rudd and Neil, {Christopher J.} and Janaki Srivanasan and Baljit Jagpal and John Horowitz and Michael Frenneaux and Dawson, {Dana K.}",

note = "Acknowledgment: The authors would like to thank all National Health Service Consultant Colleagues at Aberdeen Royal Infirmary for help with prompt recruitment of these patients (Dr. M Metcalfe, MD, Dr. AD Stewart, MD, Dr. A Hannah, MD, Dr. A Noman, MD, Dr. P Broadhurst, MD, Dr. D Hogg, MD, and Dr. D Garg, MD) and to Dr. Gordon Prescott, PhD for help and advice with the statistical methods. This work was supported by a Tenovus Scotland, Nice, France award to Dr. Dawson and presented in part at the Society for Cardiovascular Magnetic Resonance Imaging/EuroCMR 2015 Joint Scientific Sessions from February 5 2015 to February 7, 2015",

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T1 - Right Ventricular Involvement and Recovery after Acute Stress-Induced (Tako-tsubo) Cardiomyopathy

AU - Scally, Caroline

AU - Ahearn, Trevor

AU - Rudd, Amelia

AU - Neil, Christopher J.

AU - Srivanasan, Janaki

AU - Jagpal, Baljit

AU - Horowitz, John

AU - Frenneaux, Michael

AU - Dawson, Dana K.

N1 - Acknowledgment: The authors would like to thank all National Health Service Consultant Colleagues at Aberdeen Royal Infirmary for help with prompt recruitment of these patients (Dr. M Metcalfe, MD, Dr. AD Stewart, MD, Dr. A Hannah, MD, Dr. A Noman, MD, Dr. P Broadhurst, MD, Dr. D Hogg, MD, and Dr. D Garg, MD) and to Dr. Gordon Prescott, PhD for help and advice with the statistical methods. This work was supported by a Tenovus Scotland, Nice, France award to Dr. Dawson and presented in part at the Society for Cardiovascular Magnetic Resonance Imaging/EuroCMR 2015 Joint Scientific Sessions from February 5 2015 to February 7, 2015

PY - 2016/3/1

Y1 - 2016/3/1

N2 - Acute stress-induced (Tako-tsubo) cardiomyopathy is an increasingly recognized but insufficiently characterized syndrome. Here, we investigate the pathophysiology of right ventricular (RV) involvement in Tako-tsubo and its recovery time course. We prospectively recruited 31 patients with Tako-tsubo with predominantly ST-elevation electrocardiogram and 18 controls of similar gender, age, and co-morbidity distribution. Patients underwent echocardiography and cardiac magnetic resonance (CMR) imaging on a 3T Philips scanner in the acute phase (day 0 to 3 after presentation) and at 4-months follow-up. Visually, echocardiography was able to identify only 52% of patients who showed RV wall motion abnormalities on CMR. Only CMR-derived RV ejection fraction (p = 0.01) and echocardiography-estimated pulmonary artery pressure (p = 0.01) identify RV functional involvement in the acute phase. Although RV ejection fraction normalizes in most patients by 4 months, acutely there is RV myocardial edema in both functioning and malfunctioning segments, as measured by prolonged native T1 mapping (p = 0.02 for both vs controls), and this persists at 4 months in the acutely malfunctioning segments (p = 0.002 vs controls). The extracellular volume fraction was significantly increased acutely in all RV segments and remained increased at follow-up compared with controls (p = 0.004 for all). In conclusion, in a Tako-tsubo population presenting predominantly with ST-elevation electrocardiogram, we demonstrate that although RV functional involvement is seen in only half of the patients, RV myocardial edema is present acutely throughout the RV myocardium in all patients and results in microscopic fibrosis at 4-month follow-up.

AB - Acute stress-induced (Tako-tsubo) cardiomyopathy is an increasingly recognized but insufficiently characterized syndrome. Here, we investigate the pathophysiology of right ventricular (RV) involvement in Tako-tsubo and its recovery time course. We prospectively recruited 31 patients with Tako-tsubo with predominantly ST-elevation electrocardiogram and 18 controls of similar gender, age, and co-morbidity distribution. Patients underwent echocardiography and cardiac magnetic resonance (CMR) imaging on a 3T Philips scanner in the acute phase (day 0 to 3 after presentation) and at 4-months follow-up. Visually, echocardiography was able to identify only 52% of patients who showed RV wall motion abnormalities on CMR. Only CMR-derived RV ejection fraction (p = 0.01) and echocardiography-estimated pulmonary artery pressure (p = 0.01) identify RV functional involvement in the acute phase. Although RV ejection fraction normalizes in most patients by 4 months, acutely there is RV myocardial edema in both functioning and malfunctioning segments, as measured by prolonged native T1 mapping (p = 0.02 for both vs controls), and this persists at 4 months in the acutely malfunctioning segments (p = 0.002 vs controls). The extracellular volume fraction was significantly increased acutely in all RV segments and remained increased at follow-up compared with controls (p = 0.004 for all). In conclusion, in a Tako-tsubo population presenting predominantly with ST-elevation electrocardiogram, we demonstrate that although RV functional involvement is seen in only half of the patients, RV myocardial edema is present acutely throughout the RV myocardium in all patients and results in microscopic fibrosis at 4-month follow-up.

U2 - 10.1016/j.amjcard.2015.11.057

DO - 10.1016/j.amjcard.2015.11.057

M3 - Article

SN - 0002-9149

VL - 117

SP - 775

EP - 780

JO - The American Journal of Cardiology

JF - The American Journal of Cardiology

IS - 5

ER -

Right Ventricular Involvement and Recovery after Acute Stress-Induced (Tako-tsubo) Cardiomyopathy

Abstract

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