Key result
Abnormal strain across all three left ventricular regions was associated with a significantly longer average length of hospital stay compared to those without (8 days vs 3.44 days, P=0.02).
Why the study?
Takotsubo cardiomyopathy is traditionally classified into four types based on gross visual assessment, and the authors evaluated whether using LVGLS, LV segmental longitudinal strain, and RVFWS to classify TTC is feasible and advantageous.
Does echocardiography-based strain analysis provide better prognostic classification than traditional visual assessment in patients with Takotsubo cardiomyopathy?
Observational (n=25)
Blinded reviewers
Does echocardiography-based strain analysis provide better prognostic classification than traditional visual assessment in patients with Takotsubo cardiomyopathy?
Echocardiography-based strain analysis reveals that the entire left ventricle is affected in most Takotsubo cardiomyopathy patients and provides better prognostic value for hospital length of stay and cardiovascular events than traditional visual classification.
May aid prognostic stratification in Takotsubo cardiomyopathy; hypothesis-generating and leaves open superiority to visual assessment.
BACKGROUND: Takotsubo cardiomyopathy (TTC) is classified into 4 types depending on the anatomical area affected identified on gross visual assessment. We have sought to understand if it is feasible and advantageous to use left ventricular global longitudinal strain (LVGLS), LV segmental longitudinal strain and right ventricle free wall strain (RVFWS) to classify TTC.METHODS: We conducted a retrospective observational study on twenty-five patients who meet the Modified Mayo Clinic Criteria for TTC [1]. Two independent reviewers performed strain analysis, they were both blinded to patient’s diagnosed classification and outcomes.RESULTS: Based on classification by traditional assessment the 92% (N.=23) were diagnosed with typical TTC, indicating apical involvement. The entire LV was affected, 67% (N.=16) had abnormal strain (STE>-18) in all three LV regions (base, mid-ventricle and apex). Seventy-one percent of patients (N.=17) had abnormal LVGLS (>-18). Abnormal strain across all three LV regions was associated with higher prevalence (70%, N.=8 Vs 30%, N.=4, respectively) of composite cardiovascular events and longer length of hospital stay. There was a statistically significant difference in average length of hospital stay in those patients who had abnormal strain in all three regions compared to those that did not have abnormal strain across all three regions (8 days compared to 3.44 days, P=0.02).CONCLUSIONS: A new classification of TCC based on strain analysis should be developed. The traditional model is arbitrary; it fails to recognize that in most patients the entire LV is affect, it does not have prognostic significance and the most prevalent typical variant indicates apical involvement. Our study suggests that the entire LV is affected, and strain analysis has prognostic significance.
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Reddin et al. (2022) conducted an observational in Takotsubo cardiomyopathy (n=25). Abnormal strain in all three left ventricular regions vs. No abnormal strain across all three left ventricular regions was evaluated on Average length of hospital stay (p=0.02). Abnormal strain across all three left ventricular regions was associated with a significantly longer average length of hospital stay compared to those without (8 days vs 3.44 days, P=0.02).
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