Persistent left atrial mechanical dysfunction and long-term risk in Takotsubo syndrome

This study aims to investigate left atrial (LA) functional recovery following a TTS episode and assess its association with long-term major adverse cardiovascular events (MACE).

In a multicenter, prospective study, 98 consecutive TTS patients (mean age 71 ± 11 years; 94.9% women) with adequate six months left atrial strain imaging were included. LA reservoir (LASr) and contractile strain (LASct) were assessed and compared with 82 healthy controls. A longitudinal strain analysis was performed in a subset of 40 patients evaluated during the acute phase and at six months. MACE were recorded during 45 ± 14 months follow-up. Despite normalization of LV ejection fraction, at six months LASr and LASct were significantly lower compared with controls (32.9 ± 11.8% vs 42.4 ± 10.9%, p < 0.01; 17.2 ± 7.3% vs 20.9 ± 9.7%, p = 0.02). In the longitudinal subset, LV strain improved significantly over time, whereas LA strain showed no recovery. During follow-up 14 patients (14%) experienced MACE. In multivariable Cox regression analysis including age, sex, physical stressor, and admission LV ejection fraction, the addition of LASr at six months significantly improved model fit (Δχ² = 6.6, p = 0.01). LASr emerged as the only independent predictor of long-term MACE (HR 0.93, 95% CI 0.88-0.98; p = 0.01). An LASr <30% identified a high-risk subgroup with reduced event-free survival (log-rank p < 0.01).

Impaired LASr at six months is associated with long-term MACE in Takotsubo syndrome despite recovery of left ventricular systolic function.