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

Caroline Scally*, Christopher J. Neil, Janaki Srinivasan, Baljit Jagpal, Bernice K. Ng, Michael P. Frenneaux, John Horowitz, Dana K. Dawson

*Corresponding author for this work

Research output: Contribution to journalAbstract

Abstract

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.
Original languageEnglish
Article numberP280
Number of pages1
JournalJournal of Cardiovascular Magnetic Resonance
Volume17
Issue numberSuppl. 1
DOIs
Publication statusPublished - 3 Feb 2015

Fingerprint

Takotsubo Cardiomyopathy
Magnetic Resonance Spectroscopy
Pulmonary Artery
Echocardiography
Pressure
Gold
Patient Rights

Keywords

  • Takotsubo cardiomyopathy
  • TTC
  • Cardiac magnetic resonance

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine
  • Radiology Nuclear Medicine and imaging
  • Radiological and Ultrasound Technology
  • Family Practice

Cite this

Right ventricular involvement in Tako-tsubo cardiomyopathy : insights from cardiovascular magnetic resonance. / Scally, Caroline; Neil, Christopher J.; Srinivasan, Janaki; Jagpal, Baljit; Ng, Bernice K.; Frenneaux, Michael P.; Horowitz, John; Dawson, Dana K.

In: Journal of Cardiovascular Magnetic Resonance, Vol. 17, No. Suppl. 1, P280, 03.02.2015.

Research output: Contribution to journalAbstract

@article{2da755f30644450a96f8edb7035847b9,
title = "Right ventricular involvement in Tako-tsubo cardiomyopathy: insights from cardiovascular magnetic resonance",
abstract = "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.",
keywords = "Takotsubo cardiomyopathy, TTC, Cardiac magnetic resonance",
author = "Caroline Scally and Neil, {Christopher J.} and Janaki Srinivasan and Baljit Jagpal and Ng, {Bernice K.} and Frenneaux, {Michael P.} and John Horowitz and Dawson, {Dana K.}",
note = "Funding Grant:G13/10 from Tenovus Scotland.",
year = "2015",
month = "2",
day = "3",
doi = "10.1186/1532-429X-17-S1-P280",
language = "English",
volume = "17",
journal = "Journal of Cardiovascular Magnetic Resonance",
issn = "1097-6647",
publisher = "BioMed Central",
number = "Suppl. 1",

}

TY - JOUR

T1 - Right ventricular involvement in Tako-tsubo cardiomyopathy

T2 - insights from cardiovascular magnetic resonance

AU - Scally, Caroline

AU - Neil, Christopher J.

AU - Srinivasan, Janaki

AU - Jagpal, Baljit

AU - Ng, Bernice K.

AU - Frenneaux, Michael P.

AU - Horowitz, John

AU - Dawson, Dana K.

N1 - Funding Grant:G13/10 from Tenovus Scotland.

PY - 2015/2/3

Y1 - 2015/2/3

N2 - 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.

AB - 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.

KW - Takotsubo cardiomyopathy

KW - TTC

KW - Cardiac magnetic resonance

UR - http://www.scopus.com/inward/record.url?scp=84928752220&partnerID=8YFLogxK

U2 - 10.1186/1532-429X-17-S1-P280

DO - 10.1186/1532-429X-17-S1-P280

M3 - Abstract

VL - 17

JO - Journal of Cardiovascular Magnetic Resonance

JF - Journal of Cardiovascular Magnetic Resonance

SN - 1097-6647

IS - Suppl. 1

M1 - P280

ER -