Mechanisms of Acute Mitral Regurgitation in Patients With Takotsubo Cardiomyopathy

Abstract

SAM and tethering of the mitral valve are independent mechanisms with differing pathophysiology that can lead to acute MR in patients with TTC.

Role of echocardiography for takotsubo cardiomyopathy: clinical and prognostic implications

“…Significant LVOTO with gradients of 20-140 mmHg is reported in 10-25% of TTC patients, who often reveals MR (Figure 3) (59)(60)(61). This phenomenon is important for decision making in clinical practice, particularly for prescribing drugs.…”

“…Acute MR is one of the serious complications and is detected in 14-25% of TTC patients (61,62). Those with significant MR reveal lower LVEF and higher pulmonary artery pressure, which may lead to acute heart failure and cardiogenic shock (61).…”

“…Those with significant MR reveal lower LVEF and higher pulmonary artery pressure, which may lead to acute heart failure and cardiogenic shock (61). Therefore, early detection by using echocardiography is important for providing appropriate patients with severe acute MR (63); whereas one study described their theory that an aggressive medical treatment of TTC should be the first priority because acute MR in TTC is reversible (61).…”

Clinical Impact of Left Ventricular Outflow Tract Obstruction in Takotsubo Cardiomyopathy

“…1,10,11 LVOT obstruction was defined as LVOT peak-to-peak pressure gradient >20 mmHg. 7, 12 Demographic and angiographic data were collected from hospital charts according to prespecified definitions. Follow-up information was obtained by hospital-chart review and/or telephone contact with the patient, relatives, or referring practitioner.…”

Letters to the Editor

“…Unfortunately, outflow tract obstruction was not routinely evaluated at admission and was only detected in 6 of our cohort of patients. Furthermore, severe mitral regurgitation, which has previously been shown to be associated with shock and often with outflow tract obstruction, 3,4 was noted only in 1 case in our cohort. Ultimately, we recognize that the identification of correlates of hypotension in TTC represents only one step toward determining causation and subsequent development of appropriate modes of therapy for the condition.…”