Left Ventricular End Diastolic Pressure, Suspected Underlying Hypertrophic Cardiomyopathy, and Takotsubo Syndrome

To the Editor:

I very much enjoyed reading the review article on takotsubo syndrome (TTS) by Sharkey and Maron,¹ published in the August 2014 issue of the Journal, in which they covered comprehensively all the facets of TTS, based on their experience, and the large, daily expanding relevant literature. I would appreciate the response of the authors on 2 issues: (1) regarding their comment “Furthermore, left ventricular (LV) diastolic function is also acutely disturbed, with an upward shift in the LV diastolic pressure-volume curve, resulting in substantially elevated LV end-diastolic pressure (LVEDP) without significant increase in LV end-diastolic volume”, most authors report that the LVEDP is normal, or even low;^2–4 and (2) regarding their comment “Persistence of mitral valve systolic anterior motion and outflow tract obstruction (with septal hypertrophy) after recovery may indicate coexisting hypertrophic cardiomyopathy (HCM)”; one should be careful not to prematurely diagnose HCM, because septal and apical “hypertrophy” may represent persisting myocardial edema, because of TTS.^5–9

Disclosures

Conflicts of Interest: None.

• John E. Madias, MD
• Icahn School of Medicine at Mount Sinai, New York, NY;
• Division of Cardiology, Elmhurst Hospital Center, Elmhurst, NY, USA

(Released online November 21, 2014)

References

• 1.    Sharkey  SW,  Maron  BJ. Epidemiology and clinical profile of takotsubo cardiomyopathy. Circ J 2014; 78: 2119–2128.
• 2.    Redfors  B,  Shao  Y,  Omerovic  E. Stress-induced cardiomyopathy (Takotsubo): Broken heart and mind? Vasc Health Risk Manag 2013; 9: 149–154.
• 3.    Chong  CR,  Neil  CJ,  Nguyen  TH,  Stansborough  J,  Law  GW,  Singh  K, et al. Dissociation between severity of takotsubo cardiomyopathy and presentation with shock or hypotension. Clin Cardiol 2013; 36: 401–406.
• 4.    Redfors  B,  Shao  Y,  Ali  A,  Sun  B,  Omerovic  E. Rat models reveal differences in cardiocirculatory profile between Takotsubo syndrome and acute myocardial infarction. J Cardiovasc Med (Hagerstown) 2014 August 8, doi:10.2459/JCM.0000000000000088.
• 5.    Kato  T,  Ban  Y,  Kuruma  S,  Ishida  S,  Doi  C,  Iura  T, et al. Two cases of reversible left ventricular hypertrophy during recovery from Takosubo cardiomyopathy. Echocardiography 2013; 30: E92–E94, doi:10.1111/echo.12139.
• 6.    Madias  JE. Two cases of reversible left ventricular hypertrophy during recovery from takotsubo cardiomyopathy: Hypertrophy or myocardial edema after an attack of takotsubo syndrome? Echocardiography 2013; 30: 989.
• 7.    Hwang  HJ,  Lee  HM,  Yang  IH,  Kim  DH,  Byun  JK,  Sohn  IS. Evolutionary change mimicking apical hypertrophic cardiomyopathy in a patient with takotsubo cardiomyopathy. Echocardiography 2014; 31: E293–E295, doi:10.1111/echo.12722.
• 8.    Roy  RR,  Hakim  FA,  Hurst  RT,  Simper  D,  Appleton  CP. Two cases of apical ballooning syndrome masking apical hypertrophic cardiomyopathy. Tex Heart Inst J 2014; 41: 179–183.
• 9.    Madias  JE. Myocardial apical hypertrophy and takotsubo cardiomyopathy. Tex Heart Inst J 2014; 41: 568.