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Correspondence |

Transient Ventricular Dysfunction Syndrome: The Evolving Nomenclature FREE TO VIEW

Nishith K. Singh, MD
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Southern Illinois University School of Medicine, Springfield, IL

Correspondence to: Nishith K. Singh, MD, 1617 Westchester Blvd 2, Springfield IL 62704; e-mail: nishith_singh2007@yahoo.com, nsingh@siumed.edu



Chest. 2008;133(6):1532. doi:10.1378/chest.07-3113
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To the Editor:

I would like to congratulate Kurowski and colleagues on their excellent work on tako-tsubo cardiomyopathy and the proposal of “Transient Left Ventricular Dysfunction Syndrome.”1The description of this novel syndrome has suffered with the lack of a consistent nomenclature and its ever-evolving picture through various reports, including the present one. For example, many case reports and case series on right ventricular involvement with a similar regional distribution as the left side have been published.25 Elesber et al4were the first to describe it on a large scale. In their study published on 25 patients with transient left ventricular apical ballooning syndrome, 8 were found to have significant transient right ventricular apical involvement on echocardiography and it was associated with a longer and critical hospitalization. Haghi et al5 reported 9 of 34 patients (26%) with tako-tsubo cardiomyopathy with regional motion abnormalities in right ventricle (visualized on cardiac MRI). In eight of nine such patients, these segmental abnormalities cleared up with follow-up. Of note, the patients also had high incidence of certain underlying conditions (systemic hypertension, hypercholesterolemia, diabetes, Graves’ disease, COPD and paroxysmal atrial fibrillation) which have the potential to adversely affect global right ventricular function. Yet, the finding seems significantly important with abnormalities being more regional and transient in nature. The distinction may be important for at least two reasons. First, the disorder affects more “globally” than it was earlier thought and second, right-sided involvement signifies a more severe impairment in left ventricular systolic function and poorer short-term prognosis as suggested by these reports. To conclude, it appears that “Transient Ventricular Dysfunction Syndrome” may thus be a more accurate choice instead of “Transient Left Ventricular Dysfunction Syndrome” in the face of existing evidence.

The author has no conflict of interest to disclose.

Kurowski, V, Kaiser, A, von Hof, K, et al (2007) Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis.Chest132,809-816. [PubMed] [CrossRef]
 
Novak, G, Kross, K, Follmer, K, et al Transient biventricular apical ballooning: a unique presentation of the ‘broken heart.’Clin Cardiol2007;30,355-358. [PubMed]
 
Nishikawa, S, Ito, K, Adachi, Y, et al Ampulla (‘takotsubo’) cardiomyopathy of both ventricles: evaluation of microcirculation disturbance using 99mTc-tetrofosmin myocardial single photon emission computed tomography and Doppler guide wire.Circ J2004;68,1076-1080. [PubMed]
 
Elesber, AA, Prasad, A, Bybee, KA, et al Transient cardiac apical ballooning syndrome: prevalence and clinical implications of right ventricular involvement.J Am Coll Cardiol2006;47,1082-1083. [PubMed]
 
Haghi, D, Athanasiadis, A, Papavassiliu, T, et al Right ventricular involvement in takotsubo cardiomyopathy.Eur Heart J2006;27,2433-2439. [PubMed]
 

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References

Kurowski, V, Kaiser, A, von Hof, K, et al (2007) Apical and midventricular transient left ventricular dysfunction syndrome (tako-tsubo cardiomyopathy): frequency, mechanisms, and prognosis.Chest132,809-816. [PubMed] [CrossRef]
 
Novak, G, Kross, K, Follmer, K, et al Transient biventricular apical ballooning: a unique presentation of the ‘broken heart.’Clin Cardiol2007;30,355-358. [PubMed]
 
Nishikawa, S, Ito, K, Adachi, Y, et al Ampulla (‘takotsubo’) cardiomyopathy of both ventricles: evaluation of microcirculation disturbance using 99mTc-tetrofosmin myocardial single photon emission computed tomography and Doppler guide wire.Circ J2004;68,1076-1080. [PubMed]
 
Elesber, AA, Prasad, A, Bybee, KA, et al Transient cardiac apical ballooning syndrome: prevalence and clinical implications of right ventricular involvement.J Am Coll Cardiol2006;47,1082-1083. [PubMed]
 
Haghi, D, Athanasiadis, A, Papavassiliu, T, et al Right ventricular involvement in takotsubo cardiomyopathy.Eur Heart J2006;27,2433-2439. [PubMed]
 
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