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Mechanisms of Acute Mitral Regurgitation in Patients with Tako-Tsubo Cardiomyopathy: An Echocardiographic Study.
MedLine Citation:
PMID:  21498669     Owner:  NLM     Status:  Publisher    
Abstract/OtherAbstract:
BACKGROUND: -Recent studies have suggested acute mitral regurgitation (MR) as a potentially serious complication of Tako-Tsubo cardiomyopathy (TTC); however, the mechanism of acute MR in TTC remains unclear. The aim of this study was to elucidate the mechanisms of acute MR in patients with TTC. METHODS AND RESULTS: -Echocardiography was used to assess the mitral valve and left ventricular outflow tract (LVOT) pressure gradient in 47 patients with TTC confirmed by coronary angiography and left ventriculography. Mitral valve assessment included coaptation distance, tenting area at mid systole in the long axis view, and systolic anterior motion of the mitral valve (SAM). Of the study patients, 12 patients (25.5%) had significant (moderate or severe) acute MR. We found lower ejection fraction (31.3±6.2 vs. 41.5±10.6%, p=0.001) and higher systolic pulmonary artery pressure (49.3±7.4 vs. 35.5±8.9mmHg, p<0.001) in patients with acute MR than in those without acute MR. Moreover, 6 of the 12 patients with acute MR had SAM with peak LVOT pressure gradient > 20mmHg (average peak LVOT pressure gradient of 81.3±35.8mmHg). The remaining 6 patients with acute MR revealed significantly greater mitral valve coaptation distance (10.9±1.6 vs. 7.8±1.4mm, p<0.001) and tenting area (2.1±0.4 vs. 0.95±0.25cm(2), p<0.001) than those without acute MR. A multivariate analysis revealed that SAM and tenting area were independent predictors of acute MR in TTC patients (all p<0.001). CONCLUSIONS: -SAM and tethering of the mitral valve are independent mechanisms with differing pathophysiology that can lead to acute MR in TTC patients.
Authors:
Masaki Izumo; Smruti Nalawadi; Maiko Shiota; Jayant Das; Suhail Dohad; Eiji Kuwahara; Yoko Fukuoka; Robert J Siegel; Takahiro Shiota
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Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2011-4-15
Journal Detail:
Title:  Circulation. Cardiovascular imaging     Volume:  -     ISSN:  1942-0080     ISO Abbreviation:  -     Publication Date:  2011 Apr 
Date Detail:
Created Date:  2011-4-18     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101479935     Medline TA:  Circ Cardiovasc Imaging     Country:  -    
Other Details:
Languages:  ENG     Pagination:  -     Citation Subset:  -    
Affiliation:
Cedars-Sinai Medical Center, Los Angeles, CA.
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