Key result
Impaired mid-lateral strain (≥ -7) and basolateral strain (≥ -10) were independent predictors of in-hospital mortality and major cardiovascular events plus in-hospital heart failure in Takotsubo syndrome.
Why the study?
Does left ventricular strain analysis predict in-hospital cardiovascular events in patients with Takotsubo syndrome?
Observational (n=100)
No
Does left ventricular strain analysis predict in-hospital cardiovascular events in patients with Takotsubo syndrome?
Assessment of LV global and segmental longitudinal strain by speckle tracking echocardiography provides important prognostic value for predicting in-hospital mortality and MACE in the acute phase of Takotsubo syndrome.
Answers are grounded in this paper and cite their sources.
May aid acute risk stratification in Takotsubo syndrome; leaves open prospective validation before guiding management.
BACKGROUND: Takotsubo syndrome (TTS) is peculiar clinical condition often resembling an acute coronary syndrome and mostly affecting postmenopausal women after a stressful trigger. TTS was initially thought to be a relatively benign condition. However, current data have shown it may be associated with considerable inpatient morbidity and carry a small, but important, mortality risk. METHODS: We hypothesized that left ventricular (LV) regional and global longitudinal strain (GLS) assessed with 2D speckle tracking echocardiography could identify early systolic functional impairment and predict in-hospital cardiovascular events. We conducted a retrospective descriptive study reviewing patients with the discharge diagnosis of TCM between 2003 and 2016 at our institution. RESULTS: One hundred patients with TSS met the Modified Mayo Clinic criteria. Using 2D speckle tracking echocardiography, two independent cardiologists assessed the LV GLS as well as the longitudinal strain (LS) of 7 individual segments [basal-septal (BS); mid-septal (MS), apical-septal (AS), apex, basal-lateral (BL), mid-lateral (ML), and apical-lateral (AL)]. The inter-observer variability was <5%. Mean age was 69.1 years, 87% were females, and 53% were African Americans. Mean initial LV EF was 32% ± 9.8%. In univariate analysis, patients with worse BL, ML, and GLS profiles (means: -5.7; -3.3, and -4, respectively) had higher in-hospital mortality (P < .05). Worse BL and ML profiles (means: -8.6 and -7.3, respectively) were associated with higher prevalence of MACE (major adverse cardiovascular outcomes) (P < .05). In a multivariate analysis, mid-lateral strain ≥ -7 and basolateral strain ≥ -10 were independent predictors of in-hospital mortality and MACE + in-hospital heart failure, respectively. CONCLUSIONS: Assessment of LV global and segmental longitudinal strain by speckle tracking has important prognostic value in the acute phase of TTS. Additional large-scale studies will be needed to confirm our findings.
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Dias et al. (2017) conducted an observational in Takotsubo syndrome (n=100). Impaired left ventricular regional and global longitudinal strain vs. Preserved strain profiles was evaluated on In-hospital mortality and MACE + in-hospital heart failure (p=< .05). Impaired mid-lateral strain (≥ -7) and basolateral strain (≥ -10) were independent predictors of in-hospital mortality and major cardiovascular events plus in-hospital heart failure in Takotsubo syndrome.
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