Trend of Global Longitudinal Strain in Takotsubo Cardiomyopathy and Clinical Predictors of Recovery

Takotsubo cardiomyopathy (TCM) is a clinical syndrome that commonly masquerades as acute coronary syndrome. Characteristically, TCM precipitated by stressful event and then diagnosed following demonstration of typical wall motion abnormalities in the absence obstructive artery disease. The transience left ventricular dysfunction, defined normalization ejection fraction (LVEF), has been hallmark TCM, it was initially considered to be benign condition. Yet recent studies patients with have demonstrated subtle structural, functional, electrocardiographic along persistent metabolic changes symptoms even after fraction1Mitsuma W. Kodama M. Ito Tanaka K. Yanagawa T. Ikarashi N. et al.Serial findings women cardiomyopathy.Am J Cardiol. 2007; 100: 106-109Abstract Full Text PDF PubMed Scopus (94) Google Scholar, 2Neil C.J. Nguyen T.H. Singh Raman B. Stansborough J. Dawson D. al.Relation delayed recovery myocardial function takotsubo subsequent quality life.Am 2015; 115: 1085-1089Abstract (36) 3Schwarz Ahearn Srinivasan Neil Scally C. Rudd A. al.Alterations cardiac deformation, timing contraction relaxation, early fibrosis accompany apparent stress-induced (takotsubo) cardiomyopathy: an end concept transience.J Am Soc Echocardiogr. 2017; 30: 745-755Abstract (65) 4Scally Mezincescu Wilson H. Srivanasan Horgan G. al.Persistent long-term cardiomyopathy.Circulation. 2018; 137: 1039-1048Crossref (121) Scholar; also shown mortality comparable syndrome.5Tornvall P. Collste O. Ehrenborg E. Järnbert-Petterson A Case-control study risk markers stress cardiomyopathy.J Coll 2016; 67: 1931-1936Crossref (106) Scholar aim this observational evaluate trends deformation between 2015 2017 at our institution. Diagnosis made using revised Mayo Clinic criteria, reviewing data, angiograms, transthoracic echocardiograms. Thirty who had serial echocardiograms obtained within 4 months index were included study. Clinical echocardiographic variables collected. Baseline global longitudinal strain (GLS) −18% used control value, on basis lower limit normal current practice. In receiving chemotherapy, customary discuss change GLS values terms percentage abnormality, rather than absolute numeric values. We sought use similar method based second echocardiogram. noted two different groups: group 1, <80% recovery, 2, >80% recovery. mean age cohort 69.5 ± 10 years, 27 (90%) women. Group 1 17 (56%), compared 13 (43.3%). At event, there no differences LVEF (30.2 6.8% vs 34.6 10.1%, P = .16) (−8.0 3.0% −8.5 3.3%, .64) groups (Figure 1). median follow-up 8.3 days, (35.7 10.5% 49 11.2%, .002) (−9.5 2.3% −12.1 4.1%, .04) improved more 2 1A). After period 49.4 (56.5 8.0% 64 5.2%, .13) both not different, but difference (−12.6 2.2% −17.5 1.7%, < .001; Figure follow-up, LVEFs, yet only five (17%) reached value −18%. emerged (<80% recovery) (>80% recovery). younger (59 76 .007) systolic blood pressure initial presentation (126 160 mm Hg, .03; 1B). higher rates β-blockers (84.6% 47%, .02) angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers 35.2%, .005; 1B) discharge. There hospitalizations period. we responses despite This suggests are present can understood assessing GLS. Patients younger, less hypertension presentation. Beta-blockers associated small cohort, suggesting further areas investigation. observations retrospective hence hypothesis generating. Long-term will needed these ascertain outcomes deformation.