Incidence and clinical significance of mitral regurgitation in Takotsubo cardiomyopathy.

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.