Assessment of Systolic and Diastolic Left Ventricular and Left Atrial Function Using Vector Velocity Imaging in Takotsubo Cardiomyopathy

Abstract

Five adult patients with Takotsubo cardiomyopathy (TC) diagnosed by usual criteria were studied with velocity vector imaging (VVI) on admission and at follow-up, when their LV function had improved, as assessed by 2D TTE wall-motion score (WMS) index. Averaged peak segmental longitudinal strain (S) in systole, and velocity (V) and strain rate (SR) in both systole and diastole were measured from apical 4- (A4C) and 2-chamber views (A2C) in all patients. The data obtained by VVI were analyzed separately for involved and uninvolved segments, which were independently assessed by WMS. In the involved segments, systolic S, V, SR, and diastolic SR improved (P-value < 0.05) on follow-up. Diastolic V showed a trend toward improvement but did not reach statistical significance. In the uninvolved segments, none of the parameters improved significantly either during systole or diastole. In three of these five patients, left atrial (LA) walls were also studied by placing region of interest (ROI) points in the middle of each wall. Peak segmental LA systolic and diastolic V and SR as well as systolic S were obtained for both involved and uninvolved LA walls which were assessed independently using WMS similar to LV. In the involved LA walls, none of the atrial systolic and diastolic parameters changed significantly but all parameters with the exception of systolic V showed a tendency toward improvement during follow-up. Among the uninvolved LA walls, none changed significantly but atrial systolic SR and, diastolic V and SR tended to increase during follow-up. Our retrospective study using VVI demonstrates that TC patients also have LV systolic and diastolic longitudinal dysfunction, not just systolic radial dysfunction as assessed by traditional 2D TTE indices. Longitudinal LA dysfunction may also be present.

Relationship between acute strain pattern and recovery in tako-tsubo cardiomyopathy and acute anterior myocardial infarction: a comparative study using two-dimensional longitudinal strain

“…They found a reversible base to apex gradient of longitudinal strain, with transient impairment of longitudinal and radial strain, extending far beyond the LAD territory, giving a circular appearance of LV dysfunction because infero lateral segments were also involved, contrarily to AMI [4][5][6][7]. A transient impairment involving not only the longitudinal, but also the radial, and circumferential strain [18], and a transient reduction of diastolic strain rate in involved segments [6] were also described. One study also assessed the LV twist mechanics by 2D-strain [7], but the qualitative evaluation of strain as performed in the present report, and its relationship with recovery, has never been assessed in TTC.…”

“…Typical tako-tsubo cardiomyopathy (TTC) mimics acute myocardial infarction involving the left anterior descending territory (AMI), sharing similar presentation, electrocardiogram (ECG) findings, and wall motion abnormalities (WMA) at the left ventricular (LV) apex [1][2][3][4][5][6][7]. However, in TTC, where the coronary angiography demonstrates no significant coronary stenosis, there is a spontaneous total recovery of WMA within days or weeks, whereas in AMI the recovery is variable after reperfusion according to the surrounding viable myocardium [8][9][10][11][12].…”

“…The post ischemic viable myocardium shows some degree of active deformation (longitudinal shortening) despite WMA [11,12]. Few data have used myocardial deformation imaging in TTC using mainly the quantitative aspect of longitudinal strain (regional peak strain, global longitudinal strain) [4][5][6]. There is no data in TTC regarding the regional strain pattern and its relationship with recovery.…”

Characterization of Left Atrial Mechanics in Hypertrophic Cardiomyopathy and Essential Hypertension Using Vector Velocity Imaging

“…13 The recognition of the upper limits of atrial function in this pathology may be of clinical relevance, by assisting in distinguishing cardiac remodeling and helping with patients' risk stratification. 14,15 During the LA reservoir period, maximal positive LA strain occurs at the end of LV systole, representing a measure of the maximal stretching of LA. The results of the present study demonstrate the usefulness of VVI in characterizing LA myocardial function in patients with HCM and hypertension.…”

Takotsubo cardiomyopathy – a clinical review

“…Despite this, there is a noticeable lack of use of quantitative echocardiographic techniques such as the strain, strain rate, or velocity vector imaging for the diagnosis and follow-up of these patients [121,122[ (Figure 2). The descriptions of diastolic function mainly use transmitral flow [123], and ignore information from the pulmonary veins or from tissue Doppler studies, and the diastolic dysfunction detected could be spurious.…”