Carbon monoxide-induced cardiomyopathy.

Abstract

BACKGROUND: Previous reports demonstrated mechanisms of cardiac toxicity in acute

carbon monoxide (CO) poisoning. Still, none established CO-induced cardiomyopathy

(CMP) as a clinical entity. The aim of this study is to investigate CO-induced

CMP in patients with acute CO poisoning in terms of its epidemiology, clinical

characteristics, and prognosis. METHODS AND RESULTS: A retrospective study was

conducted on consecutive patients who were diagnosed with acute CO poisoning at

the emergency department of Ajou University Hospital during the period of 62

month. Six hundred and twenty-six patients were diagnosed with acute CO

poisoning. During the initial echocardiography, 19 patients were abnormal: (1)

global hypokinesia/akinesia (n=7), (2) regional wall hypokinesia/akinesia [n=12;

takotsubo type (n=6), reverse takotsubo type (n=2), non-specific type (n=4)]. The

ejection fraction (EF) was 36.3+/-13.5% (from 15% to 55%) and less than 45% for

14 patients. In the follow-up echocardiography performed within 12 days after the

initial performance, most patients were found to have cardiac wall motion

abnormalities, and their EF had returned to normal (ie, EF >/=50%). CONCLUSIONS:

CO-induced CMP was identified in 3.04% (n=19) of all patients (n=626). It might

not be too critical in acute clinical courses of acute CO poisoning because the

prognosis seems favorable. Considering the common factors between CO-induced CMP

and takotsubo CMP, myocardial stunning subject to a catecholamine surge most

likely plays a central role in the development of CO-induced CMP.