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Right ventricular function quantification in Takotsubo cardiomyopathy using two-dimensional strain echocardiography.

Felix Heggemann1, Karsten Hamm2, Joachim Brade3

  • 1First Medical Department, University Medical Center Mannheim, University of Heidelberg, Mannheim, Germany.

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Takotsubo cardiomyopathy (TC) can involve right ventricular (RV) dysfunction, impacting RV fractional area change and RV peak systolic longitudinal strain. 2D strain imaging effectively assesses RV involvement in TC.

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Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Myocardial Function

Background:

  • Takotsubo cardiomyopathy (TC) is characterized by transient left ventricular dysfunction.
  • Right ventricular (RV) involvement in TC is recognized but less understood.
  • Assessing RV function is crucial for understanding TC pathophysiology and prognosis.

Purpose of the Study:

  • To characterize global and regional RV myocardial function in patients with TC using 2D strain imaging.
  • To compare RV and left ventricular (LV) systolic function between TC patients with and without RV involvement.
  • To evaluate the feasibility and discriminatory power of 2D strain imaging for RV dysfunction in TC.

Main Methods:

  • Compared RV and LV systolic function parameters between two groups of TC patients (with RV involvement vs. without) at presentation and follow-up.
  • Utilized 2D strain imaging to assess RV peak systolic longitudinal strain (RVPSS) and RV fractional area change (RVFAC).
  • Measured tricuspid annular plane systolic excursion (TAPSE), LV ejection fraction (LVEF), and LV global strain.

Main Results:

  • Patients with RV involvement showed significantly lower RVPSS, RVFAC, LVEF, and LV global strain at initial presentation compared to those without.
  • RV dysfunction parameters improved significantly upon follow-up in the RV involvement group.
  • TAPSE did not significantly differ between groups at initial presentation; regional RV strain differences were noted in mid and apical segments.
  • A RVPSS cut-off value of >-19.1% demonstrated 85% sensitivity and 71% specificity for discriminating RV involvement.

Conclusions:

  • RVFAC, RVPSS, LVEF, and LV global strain are significantly different in TC patients with RV dysfunction, unlike TAPSE.
  • 2D strain imaging is a feasible and clinically meaningful tool for assessing RV dysfunction in TC.
  • 2D strain imaging can effectively discriminate between TC patients with and without RV involvement.