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

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Cardiac Physiology

Background:

• Takotsubo syndrome (TTS) is characterized by transient left ventricular dysfunction.
• Left atrial (LA) function recovery after TTS is not well understood.
• The association between LA function and long-term outcomes in TTS is unclear.

Purpose of the Study:

• To investigate left atrial (LA) functional recovery following a TTS episode.
• To assess the association between LA strain parameters and long-term major adverse cardiovascular events (MACE) in TTS patients.

Main Methods:

• Prospective multicenter study including 98 TTS patients and 82 controls.
• Assessed LA reservoir strain (LASr) and LA contractile strain (LASct) at six months post-TTS.
• Longitudinal strain analysis in a subset of patients during acute phase and at six months.
• MACE recorded during a mean follow-up of 45 months.

Main Results:

• At six months, TTS patients had significantly lower LASr and LASct compared to controls, despite normalized LV ejection fraction.
• LA strain showed no significant recovery in the longitudinal subset, unlike LV strain.
• 14% of patients experienced MACE during follow-up.
• Impaired LASr at six months was the only independent predictor of long-term MACE (HR 0.93, p=0.01).

Conclusions:

• Impaired LA reservoir strain (LASr) persists at six months post-TTS, irrespective of LV systolic function recovery.
• LASr is a significant independent predictor of long-term MACE in TTS.
• An LASr threshold <30% identifies a high-risk subgroup for adverse events.