Clinical Impact of Left Ventricular Outflow Tract Obstruction in Takotsubo Cardiomyopathy
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- Kawaji Tetsuma
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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- Shiomi Hiroki
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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- Morimoto Takeshi
- Division of General Medicine, Department of Internal Medicine, Hyogo College of Medicine
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- Tazaki Junichi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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- Imai Masao
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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- Saito Naritatsu
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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- Makiyama Takeru
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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- Shizuta Satoshi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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- Ono Koh
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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- Kimura Takeshi
- Department of Cardiovascular Medicine, Graduate School of Medicine, Kyoto University
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Abstract
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)
Journal
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- Circulation Journal
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Circulation Journal 79 (4), 839-846, 2015
The Japanese Circulation Society
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Details 詳細情報について
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- CRID
- 1390282680084190592
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- NII Article ID
- 40020412379
- 130005130261
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- NII Book ID
- AA11591968
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- ISSN
- 13474820
- 13469843
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- NDL BIB ID
- 026283915
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- PubMed
- 25739572
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- Text Lang
- en
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- Data Source
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- JaLC
- NDL
- Crossref
- PubMed
- CiNii Articles
- KAKEN
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- Abstract License Flag
- Disallowed