Residual alterations of cardiac and endothelial function in patients who recovered from Takotsubo cardiomyopathy

Abstract

Introduction Takotsubo cardiomyopathy (TCM) is characterized by transient left ventricle dysfunction. Hypothesis A residual cardiac and endothelial dysfunction is present in patients who recovered from TCM. Methods In this single‐center prospective study, patients with prior TCM were included and followed for 6.4 ± 1.6 years. All underwent comprehensive cardiac function assessment, including tissue Doppler imaging (TDI) and 2‐dimensional strain (2DS) echocardiography at their first visit. The number of circulating endothelial progenitor cells and levels of proangiogenic vascular endothelial growth factor (VEGF) and its receptor (VEGF‐R) were measured. All measurements were compared with healthy controls. Results Forty‐two women (age 58. ±8.6 years, LVEF 58.1 ± 6.1%) comprised the TCM group. Patients post‐TCM had significantly lower early velocities E′ (6 (5.0–8.0) vs. 9 (7.0–11.0) cm/s, p = .001) by TDI and higher E/E′ ratio (p = .002), lower LV global average longitudinal strain (LGS) (−18.9 ± 3.5% vs. −21.7 ± 2.3%, p = .002) and RV LGS (−20.1 ± 3.9% vs. −23.4 ± 2.8%, p = .003) were evident. There was a trend toward a higher VEGF‐R (p = .09) along with decreased VEGF/VEGF‐R ratio representing inadequate VEGF production. In‐hospital mortality was not reported and only two non‐cardiac deaths occurred at long‐term follow‐up. Conclusions Altered TDI and 2DS indices suggest residual biventricular myocardial injury in post‐TCM patients with the apparent LV function recovery. Inappropriate production of VEGF and VEGF‐R were observed, suggesting a possible underlying endothelial dysfunction in these patients.

Time Course of Left Ventricular Strain Assessment via Cardiovascular Magnetic Resonance Myocardial Feature Tracking in Takotsubo Syndrome

“…CMR-FT is useful for evaluating LV deformation of TTS, and the transient contraction abnormalities in TTS can be quantitatively assessed with CMR-FT [ 8 ]. Some studies reported residual alterations of cardiac deformation in TTS patients using two-dimensional strain echocardiography [ 9 ]. A few data have been published on residual changes in cardiac function of patients with prior recovered TTS using CMR-FT showing deformation abnormalities that may persist despite normalization of global LV function at follow-up of 3 months [ 8 ].…”