Time Course of Functional Recovery in Takotsubo (Stress) Cardiomyopathy: A Serial Speckle Tracking Echocardiography and Electrocardiography Study

Abstract

BACKGROUND: Although rapid recovery of cardiac contraction is a hallmark of Takotsubo cardiomyopathy (TTC), the time course of recovery is still ill-defined. We aimed to investigate the time course of left ventricular (LV) functional recovery using 2D speckle tracking echocardiography and electrocardiography (ECG). METHODS: Thirty-two consecutive patients (65 ± 16 years, 26 women) with TTC were prospectively recruited. ECG and echocardiography were performed at baseline (No. 1), before discharge (No. 2), and at 1 week (No. 3) and 5 weeks (No. 4) after discharge. Echocardiographic images and ECGs were analyzed to measure ejection fraction (LVEF), global and regional longitudinal strain (GLS, RLS), and T wave inversion (TWI) scores.

More than the eye can see: Left ventricular global longitudinal strain assessment in patient with Takotsubo Cardiomyopathy within a 9-month follow-up

“…In our report, we describe a case of Takotsubo cardiomyopathy with changing LV systolic function assessed by LVEF and GLS throughout the acute and subacute phases (lasting approximately 1 month) and gradual recovery to baseline over the following 8 months. Our work is consistent with other studies reporting the presence of subtle LV dysfunction, even after the normalization of LVEF [1,3]. We believe this is the first case reported in the literature showing the long-term sequential evaluation of GLS in TTC patient.…”

“…Takotsubo cardiomyopathy (TTC) is a cardiac condition characterized by acute but reversible left ventricular (LV) dysfunction, in the absence of obstructive coronary artery disease [1][2][3]. Two-dimensional (2D) speckle-tracking echocardiography (STE) is a useful method for evaluating global and regional left ventricular function, and consistently more sensitive than conventional echocardiography in detecting minor myocardial abnormalities [1]. The utility of STE in TTC patients has been described in a few short-term reports [1][2][3][4], however there is limited understanding around the time course of functional recovery in TTC patients [1].…”

“…Two-dimensional (2D) speckle-tracking echocardiography (STE) is a useful method for evaluating global and regional left ventricular function, and consistently more sensitive than conventional echocardiography in detecting minor myocardial abnormalities [1]. The utility of STE in TTC patients has been described in a few short-term reports [1][2][3][4], however there is limited understanding around the time course of functional recovery in TTC patients [1]. In this article, we present a case of a 30-year-old female with sequential evaluation of global longitudinal strain (GLS) during a 9 month follow-up.…”

Takotsubo Cardiomyopathy: Current Treatment

“…Indeed, the commonality excessively voiced that we need special, evidence-based medicine TTS-directed randomized controlled trials (RCT) to decide on specific therapies for TTS may be impractical and perhaps not even necessary, because even at the time point of patients’ hospital admission, TTS has probably been “finalized”, and the condition is in its process of recovery. The above constitutes a personal opinion expressed repeatedly [ 6 , 11 ], may apply only to a subset of patients with TTS, and can be tangentially supported by the fact that the diagnosis of TTS is often made with considerable delay, after patients have been treated sometimes for several days as having ACS or AMI, by the rapid partial or complete recovery of the left ventricular (LV) function (sometimes within hours to 2 days), following prompt clinical presentation after the onset of the illness [ 13 , 14 , 15 , 16 ], or by the fact that some patients with TTS are found to have normal cardiac troponin values and/or almost normal LV function shortly after admission. Thus, therapy needs to focus on the management of established TTS pathophysiologic/pathologoanatomic/pathohistologic consequences, and complications.…”

MFGE8, ALB, APOB, APOE, SAA1, A2M, and C3 as Novel Biomarkers for Stress Cardiomyopathy

“…Stress cardiomyopathy, also known as takotsubo cardiomyopathy (TTC), was first reported in Japan in 1990 [1], characterized by transient systolic and diastolic left ventricular (LV) dysfunction with multiple wall dyskinesia, most commonly occurring in postmenopausal women, especially in populations with a recent history of mental or physical stress [2]. The reversibility of cardiac insufficiency is one of the most prominent features of the disease.…”