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Usefulness of left ventricular strain analysis in patients with takotsubo syndrome during acute phase
Author(s) -
Dias Andre,
Franco Emiliana,
Rubio Manolo,
Bhalla Vikas,
Pressman Gregg S.,
Amanullah Sarah,
Hebert Kathy,
Figueredo Vincent M.
Publication year - 2018
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.13762
Subject(s) - medicine , takotsubo syndrome , cardiology , basal (medicine) , mace , univariate analysis , speckle tracking echocardiography , multivariate analysis , interventricular septum , ventricle , heart failure , cardiomyopathy , myocardial infarction , ejection fraction , conventional pci , insulin
Background Takotsubo syndrome (TTS) is peculiar clinical condition often resembling an acute coronary syndrome and mostly affecting postmenopausal women after a stressful trigger. TTS was initially thought to be a relatively benign condition. However, current data have shown it may be associated with considerable inpatient morbidity and carry a small, but important, mortality risk. Methods We hypothesized that left ventricular (LV) regional and global longitudinal strain (GLS) assessed with 2D speckle tracking echocardiography could identify early systolic functional impairment and predict in‐hospital cardiovascular events. We conducted a retrospective descriptive study reviewing patients with the discharge diagnosis of TCM between 2003 and 2016 at our institution. Results One hundred patients with TSS met the Modified Mayo Clinic criteria. Using 2D speckle tracking echocardiography, two independent cardiologists assessed the LV GLS as well as the longitudinal strain (LS) of 7 individual segments [basal‐septal (BS); mid‐septal (MS), apical‐septal (AS), apex, basal‐lateral (BL), mid‐lateral (ML), and apical‐lateral (AL)]. The inter‐observer variability was <5%. Mean age was 69.1 years, 87% were females, and 53% were African Americans. Mean initial LV EF was 32% ± 9.8%. In univariate analysis, patients with worse BL, ML, and GLS profiles (means: −5.7; −3.3, and −4, respectively) had higher in‐hospital mortality ( P < .05). Worse BL and ML profiles (means: −8.6 and −7.3, respectively) were associated with higher prevalence of MACE (major adverse cardiovascular outcomes) ( P < .05). In a multivariate analysis, mid‐lateral strain ≥ −7 and basolateral strain ≥ −10 were independent predictors of in‐hospital mortality and MACE + in‐hospital heart failure, respectively. Conclusions Assessment of LV global and segmental longitudinal strain by speckle tracking has important prognostic value in the acute phase of TTS. Additional large‐scale studies will be needed to confirm our findings