| Clinical implications of midventricular obstruction and intravenous propranolol use in transient left ventricular apical ballooning (Tako-tsubo cardiomyopathy). | |
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MedLine Citation:
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PMID: 18294491 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND: Persistent hypotension with dynamic midventricular obstruction (MVO) in patients with transient left ventricular (LV) apical ballooning (Tako-tsubo cardiomyopathy) is an important complication that needs to be treated. PURPOSE: The objective of this study is to determine the effects of intravenous propranolol challenge on MVO in transient LV apical ballooning. SUBJECTS AND METHODS: Thirty-four patients (12 males, 22 females, mean age 64 +/- 17 years, age range 22-84 years) with LV apical ballooning were enrolled. The hemodynamic and echocardiographic effects of propranolol (0.05 mg/kg, maximum 4 mg) were analyzed in 13 patients. RESULTS: (1) Midventricular obstruction was present in 8 (24%) of 34 patients, and the pressure gradient (PG) ranged from 28 to 140 mm Hg. (2) Patients with MVO had similar demographic and clinical characteristics (symptoms, peak creatine kinase, plasma catecholamine levels) as those without MVO; however, in patients with MVO, abnormal Q waves on electrocardiogram and hypotension were more prevalent. (3) In the MVO group, intravenous propranolol changed the PG from 90 +/- 42 to 22 +/- 9 mm Hg, the systolic blood pressure (SBP) from 85 +/- 11 to 116 +/- 20 mm Hg, and the LV ejection fraction (LVEF) from 30% +/- 7% to 43% +/- 4%. (4) In all subjects, the changes in the PG after propranolol injection had a significant linear correlation with the SBP and LVEF changes: deltaSBP = 4.738 + 0.315 x deltaPG (r = 0.689 (P < .001) and deltaLVEF = 2.973 + 0.1321 x deltaPG (r = 0.715, P < .001). CONCLUSION: Intravenous propranolol is useful for treating dynamic MVO in patients with transient LV apical ballooning. |
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Authors:
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Takuji Yoshioka; Akiyoshi Hashimoto; Kazufumi Tsuchihashi; Kazuhiko Nagao; Michifumi Kyuma; Hitoshi Ooiwa; Akihiko Nozawa; Shinya Shimoshige; Mariko Eguchi; Takeru Wakabayashi; Satoshi Yuda; Mamoru Hase; Tomoaki Nakata; Kazuaki Shimamoto |
Publication Detail:
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Type: Case Reports; Journal Article; Research Support, Non-U.S. Gov't Date: 2008-01-18 |
Journal Detail:
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Title: American heart journal Volume: 155 ISSN: 1097-6744 ISO Abbreviation: Am. Heart J. Publication Date: 2008 Mar |
Date Detail:
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Created Date: 2008-02-25 Completed Date: 2008-03-13 Revised Date: - |
Medline Journal Info:
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Nlm Unique ID: 0370465 Medline TA: Am Heart J Country: United States |
Other Details:
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Languages: eng Pagination: 526.e1-7 Citation Subset: AIM; IM |
Affiliation:
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Second Department of Internal Medicine, Sapporo Medical University School of Medicine, Sapporo, Hokkaido, Japan. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Adrenergic beta-Antagonists
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administration & dosage* Adult Aged Aged, 80 and over Blood Pressure Dose-Response Relationship, Drug Echocardiography / methods Female Follow-Up Studies Humans Injections, Intravenous Male Middle Aged Propranolol / administration & dosage* Stroke Volume / physiology Takotsubo Cardiomyopathy / complications*, drug therapy, physiopathology Ventricular Outflow Obstruction / drug therapy*, etiology, physiopathology |
| Chemical | |
Reg. No./Substance:
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0/Adrenergic beta-Antagonists; 525-66-6/Propranolol |
From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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