Prevalence and Prognostic Role of Right Ventricular Involvement in Stress-Induced Cardiomyopathy

• The burden of right ventricular involvement and its prognostic role is not clear in stress cardiomyopathy.
• We analyzed a cohort of stress cardiomyopathy patients, focusing our analysis on the right ventricle.
• Right ventricular involvement is often observed in stress cardiomyopathy (50% of the patients).
• Right ventricular systolic dysfunction is a major predictor of poor prognosis.

BackgroundStress-induced cardiomyopathy (SCM) is a reversible cardiomyopathy observed in patients without significant coronary disease. The aim of this study was to assess the incidence and clinical significance of right ventricular (RV) involvement in SCM.Methods and ResultsWe retrospectively analyzed echocardiograms from 40 consecutive patients who presented with SCM at Stanford University Medical Center from September 2000 to November 2010. The primary end point was overall mortality. RV involvement was observed in 20 patients (50%; global RV hypokinesia in 15 patients and focal RV apical akinesia in 5 patients). The independent correlates of RV involvement were older age (odds ratio [OR] 1.09, 95% confidence interval [CI] 1.02–1.7two, P = .01) and LVEF (per 10% decrease: OR 3.60, CI 1.77–7.32; P = .02). At a mean follow-up of 44 ± 32 months, 12 patients (30%) died (in-hospital death in 3 patients). At multivariate analysis, the presence of an RV fractional area change <35% emerged as an independent predictor of death (OR 3.6, CI 1.06–12.41; P = .04).ConclusionsRV involvement is a common finding in SCM, and may present as either global or focal RV apical involvement. Both older age and lower LVEF are associated with a higher risk of RV involvement, which appears to be a major predictor of death.