Key result
Symptomatic prior Takotsubo syndrome exhibits a blunted exercise contractile response with ~8% lower ΔLVEF versus controls.
Why the study?
Takotsubo syndrome is usually associated with spontaneous recovery of LV function, but some patients have persistent symptoms whose haemodynamic and LV contractile responses to exercise remain undetermined.
Does exercise echocardiography reveal abnormal left ventricular contractile responses in symptomatic patients with previous Takotsubo syndrome compared to controls?
Case-Control (n=60)
Does exercise echocardiography reveal abnormal left ventricular contractile responses in symptomatic patients with previous Takotsubo syndrome compared to controls?
Absolute Event Rate: 4% vs 12%
p-value: p=<0.001
Symptomatic patients with previous Takotsubo syndrome exhibit a blunted contractile response and exercise-induced wall motion abnormalities during stress echocardiography.
Exercise echocardiography may detect residual contractile impairment in symptomatic post-Takotsubo patients; hypothesis-generating for management or prognosis.
AIMS: Takotsubo syndrome (TTS) is usually associated with rapid and spontaneous recovery of left ventricular (LV) function. However, a proportion of patients may have persistent symptoms. This study aimed to determine the haemodynamic and LV contractile responses to exercise in these patients. METHODS AND RESULTS: Thirty symptomatic TTS patients referred for exercise echocardiography, a median of 15 months following the index TTS episode, were matched with 30 controls with normal exercise echocardiography. Beta-blockers were withheld prior to the test. LV volumes, ejection fraction (EF) and wall motion score index (WMSI), were measured at rest and stress. The TTS cohort were Caucasian women with mean age of 64.6 ± 7.4 years and similar coronary risk factor profile and EF to controls. Resting systolic blood pressure (SBP), LV end-diastolic volume, wall stress, and right ventricular fractional area change were higher in TTS patients compared with controls. Stress echo data showed similar exercise time, peak heart rate, and peak SBP in TTS patients vs. controls, but TTS patients had higher LV volumes, lower exercise LVEF (70 ± 10% vs. 78 ± 7%; P = 0.001), ΔLVEF (4 ± 8% vs. 12 ± 5%; P < 0.001), and WMSI (1.4 ± 0.4 vs. 1 ± 0; P < 0.001) compared with controls. Twenty TTS patients had clear exercise-induced wall motion abnormalities, mainly involving the apex or more globally, with a mean ΔLVEF of 1% compared with 12% in controls. Among the other 10 TTS patients, the ΔLVEF was 10%. CONCLUSION: Symptomatic patients with previous TTS have a blunted contractile response to exercise. The therapeutic and prognostic implications of these findings need further investigation.
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Yakupoglu et al. (2020) conducted a case-control in Previous Takotsubo syndrome (n=60). Previous Takotsubo syndrome vs. Controls with normal exercise echocardiography was evaluated on ΔLVEF during exercise echocardiography (p=<0.001). Symptomatic patients with previous Takotsubo syndrome exhibited a blunted contractile response to exercise compared to controls, with a significantly lower ΔLVEF (4% vs. 12%; P<0.001).
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