European Heart Journal Advance Access originally published online on March 5, 2007
European Heart Journal 2007 28(8):1037-1038; doi:10.1093/eurheartj/ehl571
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Right ventricular involvement in Takotsubo cardiomyopathy
Department of Ultrasound
The First Affiliated Hospital
College of Medicine
Zhejiang University
#79 Qingchun Road
Hangzhou 310003
Zhejiang Province
PR China
Fax: +86 571 8723 6628
E-mail address: zezhou_song{at}126.com
Internal Medicine Department
Hangzhou 3rd Hospital
Hangzhou
PR China
We read with great interest the study by Haghi et al.1, which confirmed that right ventricular (RV) involvement is common in Takotsubo cardiomyopathy (TTC) and seems to be associated with a more severe impairment in left ventricular (LV) systolic function. It may be suspected by the presence of pleural effusion. The methods and interpretation of the results, however, raise several concerns.
In this study, Haghi et al.1 report that nine patients had RV wall motion abnormality (WMA) on CMR imaging, in whom relevant history included hypertension, hypercholesterolaemia, diabetes, chronic obstructive pulmonary disease, osteoporosis, goiter, Graves' disease, and paroxysmal atrial fibrillation. It is well known, however, that hypertension, hypercholesterolaemia, diabetes, chronic obstructive pulmonary disease, Graves' disease, and paroxysmal atrial fibrillation could affect LV or RV myocardial segments and global function to some extent. How could the authors discriminate RV WMA of the nine patients caused either by TTC involving RV or by the above-mentioned diseases? If the explanation is that eight of nine patients with RV involvement had a follow-up study demonstrating complete recovery or significant improvement of the initial regional WMA in this study, is there a relation of complete recovery or significant improvement of the initial regional WMA to the above-mentioned diseases to be optimal cured which could not be well described?
An echocardiography study of López- Candales et al.2 certify that maximal tricuspid annular plane systolic excursion which could well reflect RV function is not only determined by RV systolic function but also appears to depend on LV systolic function. That is to say, RV WMA on CMR imaging could be affected by LV systolic dysfunction. Haghi et al.1 also think that RV involvement in TTC seems to be associated with a more severe impairment in LV systolic function, which could affect the precise evaluation of prevalence of RV involvement in TTC and further the prehension of pathyphysiological mechanisms of TTC. RV WMA condition in patients with TTC and normal LV function needs to be studied.
References
- Haghi D, Athanasiadis A, Papavassiliu T, Suselbeck T, Fluechter S, Mahrholdt H, Borggrefe M, Sechtem U. (2006) Right ventricular involvement in Takotsubo cardiomyopathy. Eur Heart J 27:2433–2439.
[Abstract/Free Full Text] - López-Candales A, Rajagopalan N, Saxena N, Gulyasy B, Edelman K, Bazaz R. (2006) Right ventricular systolic function is not the sole determinant of tricuspid annular motion. Am J Cardiol 98:973–977.[CrossRef][Web of Science][Medline]
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