Left ventricular outflow tract obstruction in Tako-Tsubo syndrome: Stress cardiomyopathy or hypertrophic cardiomyopathy?
Refers to article:
Outflow tract obstruction and Takotsubo syndrome
Iván Javier Núñez-Gil, Juan Carlos García-Rubira, María Luaces
American Heart Journal
July 2009 (Vol. 158, Issue 1, Pages e5-e6) Full Text |
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We thank Dr Núñez-Gil, Dr García-Rubira, and Dr Luaces for their interest in our article.1, 2 We are very glad to see that these authors have found in part the same results from our study. Tako-Tsubo syndrome is now classified as a cardiomyopathy.3, 4 Left ventricular outflow tract (LVOT) obstruction may occur in Tako-Tsubo cardiomyopathy. Its prevalence was 25% in our study (vs 16% in the first reports4), and its detection is of importance because the use of inotropic agents may increase the intraventricular pressure gradient and induce cardiogenic shock.2, 5, 6 We found that a septal bulge (localized hypertrophy of the proximal interventricular septum) was systematically present in patients with LVOT obstruction and Tako-Tsubo cardiomyopathy, whereas in patients without LVOT obstruction, a septal budge was detected in only 29% (P = .002). Furthermore, history of hypertension was found in 75% of patients with LVOT obstruction versus 46% in patients without LVOT obstruction (P = .22). We recently studied patients with Tako-Tsubo cardiomyopathy using 2-dimensional speckle tracking echocardiography7: myocardial velocities are initially decreased during the acute phase, but at 1-month follow-up, no significant difference is observed between patients with Tako-Tsubo cardiomyopathy and healthy patients, suggesting a complete recovery. In hypertrophic cardiomyopathy, Serri et al8 have reported that these velocities are significantly decreased in hypertrophic cardiomyopathy. Thus, we believe that LVOT obstruction mainly occurs in Tako-Tsubo cardiomyopathy when a septal budge typically found in elderly patients is present, but this septal pattern should be distinguished from hypertrophic cardiomyopathy.
2. 2El Mahmoud R, Mansencal N, Pilliere R, et al.Prevalence and characteristics of left ventricular outflow tract obstruction in Tako-Tsubo syndrome. Am Heart J. 2008;156:543–548. Abstract | Full Text |
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3. 3Maron BJ, Towbin JA, Thiene G, et al.Contemporary definitions and classification of the cardiomyopathies: an American Heart Association Scientific Statement from the Council on Clinical Cardiology, Heart Failure and Transplantation Committee; Quality of Care and Outcomes Research and Functional Genomics and Translational Biology Interdisciplinary Working Groups; and Council on Epidemiology and Prevention. Circulation. 2006;113:1807–1816.
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4. 4Elliott P, Andersson B, Arbustini E, et al.Classification of the cardiomyopathies: a position statement from the European society of cardiology working group on myocardial and pericardial diseases. Eur Heart J. 2008;29:270–276.
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5. 5Chockalingam A, Tejwani L, Aggarwal K, et al.Dynamic left ventricular outflow tract obstruction in acute myocardial infarction with shock: cause, effect, and coincidence. Circulation. 2007;116:e110–e113.
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6. 6Prasad A, Lerman A, Rihal CS. Apical ballooning syndrome (Tako-Tsubo or stress cardiomyopathy): a mimic of acute myocardial infarction. Am Heart J. 2008;155:408–417. Abstract | Full Text |
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7. 7Mansencal N, Abbou N, Pilliere R, et al.Usefulness of two-dimensional speckle tracking echocardiography for assessment of Tako-Tsubo cardiomyopathy. Am J Cardiol. 2009;103:1020–1024. Abstract | Full Text |
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8. 8Serri K, Reant P, Lafitte M, et al.Global and regional myocardial function quantification by two-dimensional strain: application in hypertrophic cardiomyopathy. J Am Coll Cardiol. 2006;47:1175–1181. Abstract | Full Text |
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Hôpital Ambroise Paré, Pôle Radio-Cardio-Vasculaire, Université de Versailles-Saint Quentin, Centre de Référence pour les Maladies Cardiaques Héréditaires, Boulogne, France
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