Clinical Impact of Left Ventricular Outflow Tract Obstruction in Takotsubo Cardiomyopathy

• Kawaji Tetsuma

  Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University

• Shiomi Hiroki

  Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University

• Morimoto Takeshi

  Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine

• Tazaki Junichi

  Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University

• Imai Masao

  Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University

• Saito Naritatsu

  Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University

• Makiyama Takeru

  Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University

• Shizuta Satoshi

  Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University

• Ono Koh

  Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University

• Kimura Takeshi

  Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University

抄録

Background:A hyperdynamic state of the basal left ventricle sometimes results in obstruction of the left ventricular outflow tract (LVOT). However, the prevalence, clinical presentation, and prognostic effect of LVOT obstruction in takotsubo cardiomyopathy (TC) have not been fully evaluated.Methods and Results:Among 933 consecutive patients who underwent emergency coronary angiography for suspected acute coronary syndrome, 35 patients (3.8%) were diagnosed as TC. The cumulative 3-year incidence of all-cause death, cardiac death, hospitalization for congestive heart failure (CHF), and recurrent TC was 24.2%, 0.0%, 6.5%, and 12.2%, respectively. Among 27 patients with information of a LVOT pressure gradient, LVOT obstruction was present in 9 (33%). The prevalence of moderate to severe mitral regurgitation (67% vs. 11%, P=0.003), CHF (78% vs. 28%, P=0.02), and hypotension (56% vs. 5.6%, P=0.008) was significantly higher in patients with LVOT obstruction than in those without. Nevertheless, the cumulative 3-year incidence of all-cause death was not significantly different between the 2 groups (49.2% vs. 23.0%, P=0.22) with no cardiac deaths in either group. Hospitalization for CHF and recurrent TC were significantly more frequent in patients with LVOT obstruction (25.0% vs. 0.0%, P=0.04, and 25.0% vs. 6.7%, P=0.02).Conclusions:In 35 consecutive patients with TC, those with significant LVOT obstruction (33%) had a more serious clinical presentation such as CHF and hypotension, but had similar 3-year mortality rate as compared with those without. (Circ J 2015; 79: 839–846)

収録刊行物

• Circulation Journal

  Circulation Journal 79 (4), 839-846, 2015

  一般社団法人 日本循環器学会

キーワード

• Acute coronary syndrome
• Left ventricular outflow obstruction
• Takotsubo cardiomyopathy

詳細情報

• CRID: 1390282680084190592
• NII論文ID: 40020412379
• NII論文ID: 130005130261
• NII書誌ID: AA11591968
• DOI: 10.1253/circj.cj-14-1148
• ISSN: 13474820
• ISSN: 13469843
• NDL書誌ID: 026283915
• PubMed: 25739572
• Web Site: https://ndlsearch.ndl.go.jp/books/R000000004-I026283915
• Web Site: https://www.jstage.jst.go.jp/article/circj/79/4/79_CJ-14-1148/_pdf
• Web Site: https://search.jamas.or.jp/link/ui/2015311442
• 本文言語コード: en
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