Incidence and clinical significance of mitral regurgitation in Takotsubo cardiomyopathy. 2010

Dariusch Haghi, and Stefanie Röhm, and Tim Suselbeck, and Martin Borggrefe, and Theano Papavassiliu
I. Medical Department, University Hospital Mannheim, Mannheim, 68167 Germany. dariush.haghi@med.ma.uni-heidelberg.de

BACKGROUND In a previous report, acute mitral regurgitation (MR) was found to indicate the more severe end of the spectrum of Takotsubo cardiomyopathy (TC). The aim of this study was to determine the incidence and clinical significance of acute MR in TC. METHODS Early (<24 h of presentation) left ventricular (LV) angiograms of 47 patients with TC were reviewed by two blinded reviewers. MR severity was graded on a four graded scale. MR > or = grade 2 was considered significant. RESULTS Significant MR was present in nine (19%) patients. MR was severe (grade 3 or 4) in four and moderate (grade 2) in five. LV outflow tract gradients were not observed in any of these patients. Patients with and without significant MR did not differ with regard to various clinical parameters, including age, gender, type of TC, cardiovascular risk factors, presenting ECG, level of troponin I, triggering factors, ejection fraction (EF), vasopressor therapy, pulmonary edema, and survival to discharge. When patients were grouped according to the presence or absence of pulmonary edema, the only significant difference between the two groups was EF which was significantly lower in patients with pulmonary edema (40 +/- 12% vs. 50 +/- 12%, P = 0.011). CONCLUSIONS Acute MR is a noteworthy finding in TC, but it is not associated with the severity of TC. Dysfunction of mid-ventricular myocardium seems to be a conditio sine qua non, whereas LVOT obstruction does not seem to play an important role.

UI MeSH Term Description Entries
D008297 Male Males
D008944 Mitral Valve Insufficiency Backflow of blood from the LEFT VENTRICLE into the LEFT ATRIUM due to imperfect closure of the MITRAL VALVE. This can lead to mitral valve regurgitation. Mitral Incompetence,Mitral Regurgitation,Mitral Valve Incompetence,Mitral Insufficiency,Mitral Valve Regurgitation,Incompetence, Mitral,Incompetence, Mitral Valve,Insufficiency, Mitral,Insufficiency, Mitral Valve,Regurgitation, Mitral,Regurgitation, Mitral Valve,Valve Incompetence, Mitral,Valve Insufficiency, Mitral,Valve Regurgitation, Mitral
D005260 Female Females
D005858 Germany A country in central Europe, bordering the Baltic Sea and the North Sea, between the Netherlands and Poland, south of Denmark. The capital is Berlin.
D006801 Humans Members of the species Homo sapiens. Homo sapiens,Man (Taxonomy),Human,Man, Modern,Modern Man
D000368 Aged A person 65 years of age or older. For a person older than 79 years, AGED, 80 AND OVER is available. Elderly
D015897 Comorbidity The presence of co-existing or additional diseases with reference to an initial diagnosis or with reference to the index condition that is the subject of study. Comorbidity may affect the ability of affected individuals to function and also their survival; it may be used as a prognostic indicator for length of hospital stay, cost factors, and outcome or survival.
D015994 Incidence The number of new cases of a given disease during a given period in a specified population. It also is used for the rate at which new events occur in a defined population. It is differentiated from PREVALENCE, which refers to all cases in the population at a given time. Attack Rate,Cumulative Incidence,Incidence Proportion,Incidence Rate,Person-time Rate,Secondary Attack Rate,Attack Rate, Secondary,Attack Rates,Cumulative Incidences,Incidence Proportions,Incidence Rates,Incidence, Cumulative,Incidences,Person time Rate,Person-time Rates,Proportion, Incidence,Rate, Attack,Rate, Incidence,Rate, Person-time,Rate, Secondary Attack,Secondary Attack Rates
D054549 Takotsubo Cardiomyopathy A transient left ventricular apical dysfunction or ballooning accompanied by electrocardiographic (ECG) T wave inversions. This abnormality is associated with high levels of CATECHOLAMINES, either administered or endogenously secreted from a tumor or during extreme stress. Tako-Tsubo Cardiomyopathy,Tako-Tsubo Syndrome,Apical Ballooning Syndrome,Broken Heart Syndrome,Left Ventricular Apical Ballooning Syndrome,Stress Cardiomyopathy,Takotsubo Syndrome,Transient Apical Ballooning Syndrome,Cardiomyopathy, Stress,Cardiomyopathy, Tako-Tsubo,Cardiomyopathy, Takotsubo,Syndrome, Tako-Tsubo,Tako Tsubo Cardiomyopathy,Tako Tsubo Syndrome,Tako-Tsubo Cardiomyopathies,Tako-Tsubo Syndromes
D018570 Risk Assessment The qualitative or quantitative estimation of the likelihood of adverse effects that may result from exposure to specified health hazards or from the absence of beneficial influences. (Last, Dictionary of Epidemiology, 1988) Assessment, Risk,Benefit-Risk Assessment,Risk Analysis,Risk-Benefit Assessment,Health Risk Assessment,Risks and Benefits,Analysis, Risk,Assessment, Benefit-Risk,Assessment, Health Risk,Assessment, Risk-Benefit,Benefit Risk Assessment,Benefit-Risk Assessments,Benefits and Risks,Health Risk Assessments,Risk Analyses,Risk Assessment, Health,Risk Assessments,Risk Benefit Assessment,Risk-Benefit Assessments

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