Diastolic function improves after resolution of takotsubo cardiomyopathy

Takotsubo cardiomyopathy (TTC) is a condition of reversible left ventricular (LV) systolic dysfunction. However, the diastolic function (DF) manifestations of TTC have not been widely investigated. We performed a bicentric study with retrospective analysis of DF in patients with TTC, during onset and at follow-up.

Twenty-eight patients with TTC (64 ± 10 years, F 24) were included. All underwent echocardiograms acutely and at the recovery phase (average three months later). Diastolic and systolic function parameters were recorded, including E-wave velocity (E), A-wave velocity, E/A ratio, relaxation (e') and contractility (S') based on tissue Doppler velocities of the mitral annuli, ejection fraction (EF), left atrial (LA) size and DF stages.

Recovery, including the mean difference with 95% confidence interval, was associated with tending improvement (i.e. uncorrected significance) in E [13 cm s(-1) (-24, -2·3), P = 0·02] and in E/A ratio [0·2 (-0·41, -0·02), P = 0·04], as well as significant improvement (after multiple comparison correction) in mean e' [2·0 cm s(-1) (-3·3, -1·2), P<0·001] and in A-wave duration [29 ms (-46·7, -12·7), P = 0·002]. LA area tended to decrease during recovery [-2 cm² (0·33, 2·4), P = 0·01]. Improvement in DF stages was significant between the phases (21% versus 58% defined as normal DF, P = 0·016). Improvement in LVEF correlated with improvement in mean e' (r = 0·52, P = 0·02).

TTC is associated with an acute impairment of conventional DF variables, which improves during recovery. DF recovery seems to occur in parallel with systolic recovery in patients with TTC.