Distinctive Hypertrophic Cardiomyopathy Anatomy and Obstructive Physiology in Patients Admitted With Takotsubo Syndrome

Sherrid, Mark V.; Riedy, Katherine; Rosenzweig, Barry P.; Massera, Daniele; Sarić, Muhamed; Swistel, Daniel G.; Ahluwalia, Monica; Arabadjian, Milla; DeFonte, Maria; Stepanovic, Alexandra; Serrato, Stephanie; Xia, Yuhe; Zhong, Judy; Maron, Martin S.; Maron, Barry J.; Reynolds, Harmony R.

doi:10.1016/j.amjcard.2020.02.013

Cited by 19 publications

(24 citation statements)

References 32 publications

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“… 12 In line with this concept, patients admitted with acute takotsubo syndrome and LVOTO during the ballooning event exhibited significantly longer residual leaflets compared to those not developing LVOTO. 27 In pivotal studies by Sherrid and colleagues, echocardiographic assessment of the post-coaptational portion relied on early-systolic measurements of residual leaflet length and distances between the mitral valve coaptation point and ventricular walls, all acquired in PLAX. 27 Of note, the mobility of the tip of the residual leaflet makes it susceptible to systolic hydrodynamic forces.…”

Section: Discussionmentioning

confidence: 99%

“… 27 In pivotal studies by Sherrid and colleagues, echocardiographic assessment of the post-coaptational portion relied on early-systolic measurements of residual leaflet length and distances between the mitral valve coaptation point and ventricular walls, all acquired in PLAX. 27 Of note, the mobility of the tip of the residual leaflet makes it susceptible to systolic hydrodynamic forces. Therefore, we measured distances between mitral leaflet tip and ventricular walls, on top of measurements at the coaptation point, acquired both at early and late systole.…”

Section: Discussionmentioning

confidence: 99%

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Spatial relationship between mitral valve and ventricular septum assessed by resting echocardiography to diagnose left ventricular outflow tract obstruction in hypertrophic cardiomyopathy

Verheyen

Batzner

Zach

et al. 2023

European Heart Journal - Cardiovascular Imaging

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Aims Echocardiographic diagnosis of left ventricular outflow tract obstruction (LVOTO) in hypertrophic cardiomyopathy (HCM) often requires extensive provocative manoeuvers. We investigated, whether echocardiography-derived parameters obtained at rest can aid to determine the presence of LVOTO in persons with HCM. Methods and results Consecutive patients with HCM admitted to a referral centre underwent standardized transthoracic echocardiographic examination including provocative manoeuvers. Under resting conditions, the length of mitral leaflets and distances between mitral valve coordinates and ventricular walls were blindly measured in parasternal long axis (PLAX) and apical three-chamber (3ch) views, both at early and late systole. Among 142 patients (mean age 59 ± 13 years, 42% women), 68 (42%) had resting or provocable LVOTO with maximal LVOT gradients ≥30 mmHg. Late-systolic distance between mitral leaflet tip and ventricular septum (TIS) was measurable in 137 participants (96%) in 3ch view and independently associated with LVOTO in multivariable logistic regression analysis. The area under the ROC curve of TIS for the identification of LVOTO was 0.91 [95% confidence interval (CI) 0.87–0.96]. TIS ≤ 14 mm yielded 97% sensitivity and 57% specificity regarding LVOTO. TIS >14 mm ruled out LVOTO with a negative predictive value of 95%. TIS ≤9 mm ruled in LVOTO with a positive predictive value of 92% (sensitivity 73%, specificity 95%). Among 43 patients with TIS between 10 and 14 mm, 35% had LVOTO. Conclusion In our study, the novel echocardiographic parameter TIS showed high negative and positive predictive values for LVOTO in HCM. These exploratory results await confirmation in larger collectives and prospective investigations.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Spatial relationship between mitral valve and ventricular septum assessed by resting echocardiography to diagnose left ventricular outflow tract obstruction in hypertrophic cardiomyopathy

Verheyen

Batzner

Zach

et al. 2023

European Heart Journal - Cardiovascular Imaging

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“…In a study cohort of 44 TTS patients with LVOTO, morphological features of hypertrophic cardiomyopathy such as high interventricular septal thickness, elongated anterior mitral leaflet, and increased mitral coaptation to posterior wall distance, were detected before TTS onset. Based on these findings it has been suggested that TTS with LVOTO may represent the clinical phenotype of hypertrophic cardiomyopathy with dynamic LV obstruction triggered by a stressor [ 40 ]. However, considering that the pathophysiological mechanism of LVOTO in TTS has been previously described, this hypothesis remains solely speculative.…”

Section: Dynamic Left Ventricular Outflow Tract Obstruction In Takotsubo Syndromementioning

confidence: 99%

Dynamic Left Intraventricular Obstruction Phenotype in Takotsubo Syndrome

Vece

Silverio

Bellino

et al. 2021

JCM

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Takotsubo syndrome (TTS) is characterized by acute, generally transient left ventricular (LV) dysfunction. Although TTS has been long regarded as a benign condition, recent evidence showed that rate of acute complications and in-hospital mortality is comparable to that of patients with acute coronary syndrome. In particular, the prevalence of cardiogenic shock ranges between 6% and 20%. In this setting, detection of mechanisms leading to cardiogenic shock can be challenging. Besides a severely impaired systolic function, onset of LV outflow tract obstruction (LVOTO) together with mitral regurgitation related to systolic anterior motion of mitral valve leaflets can lead to hemodynamic instability. Early identification of LVOTO with echocardiography is crucial and has important implications on selection of the appropriate therapy. Application of short-acting b1-selective betablockers and prudent administration of fluids might help to resolve LVOTO. Conversely, inotrope agents may increase basal hypercontractility and worsen the intraventricular pressure gradient. To date, outcomes and management of patients with TTS complicated by LVOTO as yet has not been comprehensively investigated.

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“… 3 , 4 Others, however, have shown that a minority of patients with LV ballooning have obstructive hypertrophic cardiomyopathy (OHCM), with latent obstruction and the sudden development of unrelenting high‐outflow gradients as a precipitating cause. 5 , 6 , 7 , 8 Hickam's dictum would allow >1 cause for LV ballooning.…”

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confidence: 99%

Obstructive Hypertrophic Cardiomyopathy and Takotsubo Syndrome: How to Deal With Left Ventricular Ballooning?

Citro,

Bellino,

Merli

et al. 2023

JAHA

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Currently, there are 2 proposed causes of acute left ventricular ballooning. The first is the most cited hypothesis that ballooning is caused by direct catecholamine toxicity on cardiomyocytes or by microvascular ischemia. We refer to this pathogenesis as Takotsubo syndrome. More recently, a second cause has emerged: that in some patients with underlying hypertrophic cardiomyopathy, left ventricular ballooning is caused by the sudden onset of latent left ventricular outflow tract obstruction. When it becomes severe and unrelenting, severe afterload mismatch and acute supply–demand ischemia appear and result in ballooning. In the context of 2 causes, presentations might overlap and cause confusion. Knowing the pathophysiology of each mechanism and how to determine a correct diagnosis might guide treatment.

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Distinctive Hypertrophic Cardiomyopathy Anatomy and Obstructive Physiology in Patients Admitted With Takotsubo Syndrome

Cited by 19 publications

References 32 publications

Spatial relationship between mitral valve and ventricular septum assessed by resting echocardiography to diagnose left ventricular outflow tract obstruction in hypertrophic cardiomyopathy

Spatial relationship between mitral valve and ventricular septum assessed by resting echocardiography to diagnose left ventricular outflow tract obstruction in hypertrophic cardiomyopathy

Dynamic Left Intraventricular Obstruction Phenotype in Takotsubo Syndrome

Obstructive Hypertrophic Cardiomyopathy and Takotsubo Syndrome: How to Deal With Left Ventricular Ballooning?

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