Global and segmental longitudinal and radial strain in Takotsubo versus ST-elevation myocardial infarction

It is incompletely understood why patients with takotsubo syndrome (TS) have milder symptoms and a better hemodynamic profile than patients with ST-elevation myocardial infarction (STEMI) despite similar or more extensive cardiac dysfunction. We hypothesized that this discrepancy could be due to better global longitudinal and global radial strain (GLS and GRS) in TS patients that are not apparent using conventional echocardiography.

Daily echocardiograms were performed, starting on the day of symptom onset, to compare GLS and GRS over time in women with apical TS (n = 57), and women (n = 41), and men (n = 105) with anterior STEMI. We also assessed segmental longitudinal and radial strain of remote, apparently normal myocardial segments.

At admission GLS was worse in women with TS than women and men with STEMI (GLS: -9.3 %(-10.4 %, -8.3 %) vs -11.9 %(-13.1 %, -10.6 %), and - 11.7 %(-12.5 %, -10.9 %), p = 0.002 and p = 0.001). GRS did not differ significantly between groups. Segmental longitudinal strain in remote segments was significantly worse in women with TS compared to women and men with STEMI (TS women -13.4(-14.8, -12.0), STEMI women -18.0(-19.9, 16.1), and STEMI men -16.9(-17.9, -15.9)). Both GLS and GRS improved within groups between day 0 and day 30.

Contrary to our hypothesis, GLS and GRS are both depressed in the acute phase of apical TS to at least a similar extent as in anterior STEMI. Longitudinal strain appears to be affected to a greater extent in apical TS than in anterior STEMI, particularly in segments with normal radial strain that are remote to the akinetic segments.