Comparison of Left Ventricular Contractile Abnormalities in Stress-Induced Cardiomyopathy versus Obstructive Coronary
Alexandros Briasoulis1, Karolina Marinescu1, Marian Mocanu1
1Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
Insights
Takotsubo cardiomyopathy (TC) and acute myocardial infarction (AMI) show similar impairments in left ventricular (LV) strain. Two-dimensional strain imaging can help distinguish between TC patterns.
Area of Science:
- Cardiology
- Medical Imaging
- Cardiomyopathy Research
Background:
- Limited data exists on left ventricular (LV) strain profiles in takotsubo cardiomyopathy (TC) compared to obstructive coronary artery disease (CAD).
- Investigating regional and global LV longitudinal strain in TC patients is crucial.
Purpose of the Study:
- To compare regional and global LV longitudinal strain in patients with TC versus acute cardiomyopathy (ACM) due to severe obstructive coronary artery disease.
- To utilize two-dimensional strain imaging (2DS) for this comparison.
Main Methods:
- Transthoracic echocardiography was performed on 34 TC patients, 24 ACM patients, and 30 healthy controls.
- Segmental longitudinal strain was measured using EchoInsight Epsilon software.
- Left ventricular global longitudinal strain (GLS) was calculated by averaging segmental wall strains.
Main Results:
- Both TC and ACM groups showed significantly impaired systolic and diastolic function compared to controls.
- LV global and segmental systolic strain were significantly attenuated in TC and ACM patients versus controls (P < 0.001).
- LV basal segmental longitudinal strain was higher in TC patients than ACM patients (P = 0.02).
- Global and apical segmental strain differentiated mid-ventricular from apical TC variants (P = 0.001).
Conclusions:
- Longitudinal LV strain parameters are similarly impaired in TC and ACM patients.
- Two-dimensional LV strain parameters can aid in differentiating between TC patterns.
Background:
Data on left ventricular (LV) strain profiles in patients with takotsubo cardiomyopathy (TC) in comparison with obstructive coronary artery disease (CAD) are limited. We sought to investigate regional and global LV longitudinal strain in a cohort of patients with known TC using two-dimensional strain imaging (2DS) in comparison with patients with acute cardiomyopathy (ACM) due to severe obstructive left anterior descending arterial disease or triple-vessel disease and healthy controls.
Methods:
Transthoracic echocardiography was performed in 34 patients with established TC, 24 patients with ACM, and 30 healthy subjects. We measured the segmental longitudinal strain in apical views by the use of EchoInsight Epsilon software. Left ventricular global longitudinal strain (GLS) was calculated by averaging segmental wall strains.
Results:
The TC and ACM groups were comparable for age and demographic characteristics. Systolic and diastolic function were significantly impaired in both groups compared to controls. LV global and segmental systolic strain was also significantly attenuated in patients with TC and ACM compared to controls (P < 0.001). Moreover, LV basal segmental longitudinal strain was higher in the patients with TC compared to ACM (P = 0.02). Global and apical segmental strain appear to be higher in patients with mid-ventricular variant compared to those with apical variant of TC with apical strain cutoff value of -7.85%, offering the best discriminatory value for differentiating these two patterns (P = 0.001).
Conclusions:
The results of this hypothesis-generating study indicate that longitudinal LV strain parameters are similarly impaired in patients with TC and ACM due to severe obstructive left anterior descending arterial disease or triple-vessel disease. Assessment of two-dimensional LV strain parameters could help differentiate between different TC patterns.
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