Characterization and Prognostic Value of Longitudinal Strain in the Different Patterns of Takotsubo Syndrome

Global longitudinal strain (GLS) has shown greater sensitivity than left ventricle (LV) ejection fraction to assess myocardial dysfunction in takotsubo syndrome (TTS). The aim of this study is to evaluate the GLS and segmental longitudinal strain (LS) in the different contractility patterns of TTS and to assess their prognostic value.

In this double-center retrospective study, consecutive TTS patients were included. Patients were distributed according to LV wall motion abnormalities, and GLS and LS were assessed. The development of MACE at 1-year follow-up included all-cause death, heart failure event, acute myocardial infarction, stroke, and hospitalization for symptomatic arrhythmias.

One hundred sixty-three patients were included. Median GLS value was -10.5% (IQR -13.5/-7.4). The classical TTS pattern presented the worst GLS values (-9.7% IQR -12.9/-7.1; p = 0.005). Apical and mid-ventricular LS were the most impaired among LV regions (-8.9% IQR -14.8/-6.1 and -9.1% IQR -13.0/-6.8; p < 0.001, respectively), whereas the left anterior descending territory LS was the most affected (-9.5% IQR -14.0/-7.0; p = 0.002). The incidence of MACE at 1-year follow-up was 24.2%. After a multivariable Cox regression analysis, poorer GLS values (HR: 2.62 [95% CI: 1.14-6.02]; p = 0.023), age > 75 years (HR: 3.78 [95% CI: 1.60-8.91]; p = 0.002), and secondary TTS forms (HR: 2.46 [95% CI: 1.11-5.47]; p = 0.027) were independent predictors of MACE.

Macroscopic alterations present in TTS patients do not correspond to the real involvement of the LV. Apical, mid-ventricular, and LAD territory LS values were the most impaired. Worse GLS values at admission, age > 75 years, and secondary TTS forms were independent predictors of MACE at 1-year follow-up in these patients.