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European Heart Journal Advance Access published online on September 25, 2006
European Heart Journal, doi:10.1093/eurheartj/ehl274
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European Heart Journal © The European Society of Cardiology 2006; all rights reserved
Received June 15, 2006
Revised August 3, 2006
Accepted September 11, 2006

Clinical research

Right ventricular involvement in Takotsubo cardiomyopathy

Dariusch Haghi 1, Anastasios Athanasiadis 2, Theano Papavassiliu 1 *, Tim Suselbeck 1, Stephan Fluechter 1, Heiko Mahrholdt 2, Martin Borggrefe 1, and Udo Sechtem 2

1 Medical Department, University Hospital Mannheim, Theodor-Kutzer-Ufer 1-3, Mannheim 68167, Germany
2 Division of Cardiology, Robert-Bosch-Krankenhaus, Stuttgart, Germany

* To whom correspondence should be addressed.
Theano Papavassiliu, E-mail: theano.papavassilliu{at}med.ma.uni-heidelberg.de


  Abstract

Aims The aim of our study is to assess the incidence and clinical significance of right ventricular (RV) involvement in Takotsubo cardiomyopathy (TTC).

Methods and results Between February 2002 and December 2005, 47 patients with TTC underwent cardiovascular magnetic resonance (CMR) at our institutions. 13 patients with delayed initial CMR were excluded. In the remaining 34 patients (32 women), RV wall motion abnormalities (WMAs) were present in nine (26%). Left ventricular ejection fraction (LVEF) was significantly lower in patients with RV involvement (40 ± 6 vs. 48 ± 10%, P = 0.04). The most frequently affected RV segments were the apico-lateral (89%), the antero-lateral (67%), and the inferior segment (67%). All RV WMA improved or disappeared in eight of nine patients who underwent a follow-up CMR study. Pleural effusion was more common in patients with RV involvement (67 vs. 8%, P < 0.001) and was predictive of RV dysfunction (sensitivity 67% and specificity 92%). Significant or bilateral pleural effusions were seen exclusively in patients with RV involvement.

Conclusion RV involvement is common in TTC and seems to be associated with a more severe impairment in LV systolic function. It may be suspected by the presence of pleural effusion.

Keywords: Takotsubo cardiomyopathy; Apical ballooning syndrome; Right ventricle.
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