Mechanical interventricular dependency supports hemodynamics in tako-tsubo cardiomyopathy

Juan Lei; Zhongxia Sun; Lingchun Lyu; Randall G. Green; Ernest Scalzetti; David Feiglin; Jingfeng Wang; Kan Liu

doi:10.21037/jtd.2018.04.143

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Mechanical interventricular dependency supports hemodynamics in tako-tsubo cardiomyopathy

Journal article

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Mechanical interventricular dependency supports hemodynamics in tako-tsubo cardiomyopathy

Juan Lei, Zhongxia Sun, Lingchun Lyu, Randall G. Green, Ernest Scalzetti, David Feiglin, Jingfeng Wang and Kan Liu

Journal of thoracic disease, Vol.10(5), pp.3027-3038

05/01/2018

DOI: 10.21037/jtd.2018.04.143

PMCID: PMC6006059

PMID: 29997970

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Abstract

Background: Although morphological abnormalities of the heart appear to be remarkable, most patients with tako-tsubo cardiomyopathy (TTC) remain clinically stable. We investigate real time changes in the left ventricular (LV) and right ventricular (RV) mechanics and function to explore the mechanism to preserve hemodynamics. Methods: With deformation and Doppler echocardiography, we evaluated myocardial mechanics and ventricular function/ hemodynamics simultaneously in 103 consecutive TTC patients admitted from 01/01/2008 through 12/31/2015. The coronary angiography and left ventriculography were performed to rule out culprit coronary artery stenosis (CAS). We included 66 patients in a control group with matched age, sex, and risk factors for coronary artery disease (CAD), and 41 patients in a group of myocardial infarction induced cardiogenic shock, who required circulatory supporting devices to maintain hemodynamic stability. Results: Although systolic myocardial strain in most of the LV segments was significantly impaired, 4 basal LV segments remained functionally active during acute stage of TTC. The impairment in the myocardial strain of the RV apex could extend to the middle segments, but basal RV systolic strain was also preserved. Despites comparable apical to basal strain gradients, LV and RV displayed discrepant functional/ hemodynamic status. In contrast to LV, RV functional/ hemodynamic parameters appeared to be hyperdynamic. This unique RV strain pattern remained unchanged in patients with atypical (mid-LV cavity) TTC. In 41 patients with myocardial infarction induced cardiogenic shock, RV exhibited comparable mechanic and functional features with those in TTC patients. Conclusions: The identified LV and RV mechanic changes appear to support interventricular hemodynamic dependence during TTC, which may represent a universal rescue mechanism in a jeopardized or injured heart.

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Title: Subtitle: Mechanical interventricular dependency supports hemodynamics in tako-tsubo cardiomyopathy
Creators: Juan Lei - SUNY Upstate Medical University
Zhongxia Sun - Zhejiang University
Lingchun Lyu - Department of Cardiology, Lishui Hospital, Zhejiang University, Hangzhou 310003, China.
Randall G. Green - SUNY Upstate Medical University
Ernest Scalzetti - SUNY Upstate Medical University
David Feiglin - SUNY Upstate Medical University
Jingfeng Wang - Sun Yat-sen Memorial Hospital
Kan Liu - SUNY Upstate Medical University
Resource Type: Journal article
Publication Details: Journal of thoracic disease, Vol.10(5), pp.3027-3038
DOI: 10.21037/jtd.2018.04.143
PMID: 29997970
PMCID: PMC6006059
NLM abbreviation: J Thorac Dis
ISSN: 2072-1439
eISSN: 2077-6624
Publisher: Ame Publ Co
Number of pages: 12
Language: English
Date published: 05/01/2018
Academic Unit: Radiology; Cardiovascular Medicine; Internal Medicine
Record Identifier: 9984318723902771

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