Left ventricular diastolic function over the acute and subacute phase in the Takotsubo syndrome versus ST-elevation myocardial infarction

BACKGROUND: Left ventricular diastolic dysfunction following Takotsubo syndrome (TS) and ST-elevation myocardial infarction (STEMI) is a marker of impaired myocardial relaxation and reduced ventricular compliance and is associated with adverse outcomes. We hypothesized that differences in diastolic function explain the better hemodynamic profile seen in TS compared to STEMI despite similar or more extensive cardiac systolic dysfunction. METHODS: Daily echocardiographic examinations including diastolic function parameters were made in women with TS (N = 69) or anterior STEMI (N = 43), starting on the day of symptom onset. The primary endpoints were a set of diastolic indices at 24 h after symptom onset. Women were also classified into diastolic subgroups based on the 2025ASE recommendations on evaluation of left ventricular diastolic function. RESULTS: TS and STEMI were balanced in age (69.4 ± 11.1 versus 69.5 ± 11.0), baseline risk factors and pre-admission cardiovascular medications. Women with TS had significantly lower S/D(p = 0.05), and higher E/é-lateral(p = 0.04), and LAVI(p = 0.05) compared to STEMI 24 h after admission. But there were no significant differences between the groups in diastolic grade, after 24 h. Longitudinal analyses of diastolic parameters over the course of the study period did not reveal any pattern suggestive of systematically worse or better diastolic function in TS than STEMI. Diastolic function parameters and diastolic function grade were similar also at 30-days follow-up in both groups. CONCLUSION: This study is the first to evaluate left ventricular diastolic function with repeated echocardiography. Because diastolic indices were similar or more impaired in TS than in STEMI, our findings do not support the hypothesis.