Abstract 9390: Cardiac Geometry, Function, and Mechanics in Biventricular Takotsubo Syndrome

Abstract

Introduction: Approximately 30% of patients with Takotsubo syndrome have biventricular involvement (BiV-TTS), which confers an increased morbidity. This study aimed to detail cardiac geometry, function and mechanics in BiV-TTS. Methods: Twenty-five patients diagnosed with BiV-TTS according to the InterTAK diagnostic criteria between 2006 to 2020 were retrospectively identified and analyzed with 2-dimensional and speckle-tracking strain echocardiography. An independent t-test, Mann-Whitney U-test, or Kruskal-Wallis test were used for the statistical analyses. Results: Mean age was 71.1 ± 17.9 years, and 56% were female. The LV ejection fraction was decreased (31.4 ± 12.2%), chamber size was increased (end-systolic volume index: 41.3 ± 10.2 ml/m2), and 48% had concentric remodeling. The right ventricular (RV) size was upper normal (40.6 ± 4.1 mm), and tricuspid annular plane systolic excursion was decreased (12.0 ± 2.6 mm). Sixteen patients had suitable images for speckle-tracking analysis. Global LV longitudinal strain was impaired (-7%, IQR -9.6 to -4.5), with significant differences between basal (-7.1%), mid (-4.3%), and apical (-0.2%) territories (P=0.001). Segmental strain within the LV base statistically varied, with the anteroseptum most impaired (-3.1%) and the inferolateral segments most preserved (-11%) (p=0.01). RV free wall strain was impaired (-9.9% ± 4.7), and differed between basal (-14.6%), mid (-11.9%), and apical (-5.4%) territories (P<0.001). Females had worse global LV (-4.6 vs. -9.5%, p=0.02) and similar RV free wall strain (-9.6 vs. -10.2%, p=0.78) impairment compared with males. Conclusions: Chamber remodeling, dysfunction, and mechanical impairment characterize BiV-TTS. Important differences exist in territorial and segmental strain values, and between genders.