American Heart Journal
Volume 158, Issue 1 , Page e3, July 2009

Left ventricular outflow tract obstruction in Tako-Tsubo syndrome: Stress cardiomyopathy or hypertrophic cardiomyopathy?

Hôpital Ambroise Paré, Pôle Radio-Cardio-Vasculaire, Université de Versailles-Saint Quentin, Centre de Référence pour les Maladies Cardiaques Héréditaires, Boulogne, France

Article Outline

 

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.

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References 

  1. Nunez-Gil IJ, García-Rubira JC, Luaces M. Outflow tract obstruction and Takotsubo syndrome. Am Heart J. 2009;158:e5–e6
  2. El 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
  3. Maron 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
  4. Elliott 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
  5. Chockalingam 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
  6. Prasad 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
  7. Mansencal 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
  8. Serri 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

PII: S0002-8703(09)00349-4

doi:10.1016/j.ahj.2009.05.007

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)

American Heart Journal
Volume 158, Issue 1 , Page e3, July 2009

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