Transient apical ballooning syndrome or Takotsubo cardiomyopathy (TC) is a novel acute cardiac syndrome, characterized by regional systolic dysfunction involving the apex and mid-ventricular segments, with hyperkinesis of the basal segments. Mid-ventricular ballooning cardiomyopathy (MVBC) is a recently recognized variant of TC. Both disorders share the same precipitating factors, clinical features and course; however, unlike TC, MVBC is characterized by ballooning and akinesis of the mid-ventricular segments with hypercontractility of the basal and apical segments. While the precise pathogenetic mechanism of this disorder remains elusive, microvascular dysfunction from excessive catecholamine release has been implicated. We report findings on regional contractile dysfunction (strain imaging), myocardial blood flow (semi-quantitative), and perfusion kinetics using myocardial contrast echocardiography in a series of three illustrative cases of TC.

SUMMARY Background Aortic stiffness and left ventricular (LV) diastolic dysfunction are common and associated with increased morbidity and mortality in systemic lupus erythematosus (SLE). Hypothesis In SLE, aortic stiffness and LV diastolic dysfunction may be associated. Methods This 6-year duration, cross-sectional, and controlled study was conducted in 76 SLE patients (69 women, mean age, 37±12 years) and 26 age-and-sex matched healthy controls. All subjects underwent clinical and laboratory evaluations and transesophageal echocardiography (TEE) to assess LV diastolic function and stiffness of the descending thoracic aorta using the Pressure-Strain Elastic Modulus (PSEM). To validate results using PSEM, aortic strain, stiffness, and distensibility were assessed. Results Patients as compared to controls had higher PSEM (8.14±4.25 versus 5.97±2.31 units, p<0.001) and had lower mitral inflow E/A and septal and lateral mitral annulus tissue Doppler E′/A′ velocity ratios, longer isovolumic relaxation time, lower septal and lateral mitral annulus E′ velocities, and higher mitral E/septal E′ and mitral E/lateral E′ velocity ratios (all p≤0.03), all indicative of LV diastolic dysfunction. In patients, PSEM was correlated with parameters of LV diastolic dysfunction (all p<0.05) and was independently negatively associated with E/A and E′/A′ ratios and E′ velocities and positively associated with E/E′ ratios (p≤0.02 for each parameter and p<0.001 for all parameters as a profile). Aortic strain, stiffness, and distensibility were also worse in patients than in controls (all p<0.05) and were correlated with parameters of LV diastolic dysfunction (all p≤0.03). Conclusion Aortic stiffness is independently associated with LV diastolic dysfunction in young adult patients with SLE.

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