Right ventricular involvement in Takotsubo syndrome

ABSTRACT
Objective Patients with right ventricular (RV) involvement Takotsubo syndrome (TTS) are risky for comorbidities, mortality and extended recovery who should be treated appropriately in early stage, however, currently large-scale clinical data are lacking. Our article reviews epidemiological, clinical and prognostic features of RV TTS in our hospital.
Methods Our study retrospectively evaluated patients diagnosed as TTS. Ventricular involvement was defined on wall motion abnormality showed by left ventriculography and echocardiography. The recovery of LVEF and pulmonary hypertension, defined as prognosis were assessed at followed-up.
Results Among 15 patients, diagnosed as TTS, 8(57.1%) were Biventricular involvement TTS (Bi-V TTS). Older ((70.33±8.37 vs 69.00±10.51), P=0.04), women (8 (88.9%), P=0.041) with lower LVEF (<50%) (8 (88.9%), P=0.020) were risky for RV TTS. At admission, for RV TTS, LVEF was lower, BNP increased significantly ((591.9 ± 162 vs 362.4 ± 116.4pg/ml), P=0.021), while cTNT and CK-MB not, changes of Electrocardiograms (3(33.3%), P=0.020), myocardial edema and myocardial fibrosis showed by Late gadolinium enhancement (LGE) of Cardiac magnetic resonance (CMR). During index admission, hydrothorax (9(100%), P=0.001), shock (1(20%), P=0.164), chronic heart failure (2(40%), P=0.158), thrombus (9(100%), P=0.001), aneurysm (1(11.1%), P=0.143), mitral and tricuspid regurgitation (moderate or higher) (7(77.8%), P=0.180) and aortic regurgitation (moderate or higher) (3(33.3%), P=0.103) associated with RV TTS. Except one patient (22.2%) died, prolonged recovery and poor prognosis were assessed by LVEF and pulmonary hypertension.
Conclusions
For RV TTS, normally associated with higher risk of comorbidities, mortality and extended recovery and should be treated appropriately in early stage to improve patient prognosis.