Trend of Global Longitudinal Strain in Takotsubo Cardiomyopathy and Clinical Predictors of Recovery

Abstract

As quoted in the letter by Hubert et al, 1 Owashi et al 3 recently proposed a very interesting mathematical model to derive with echocardiography specific LV pressure curves in patients with severe AS. Nevertheless, the proposed method also has some critical limitations: (1) it uses aortic valve area, among other parameters, to noninvasively predict the patient-specific LV pressure curve; however, calculation of aortic valve area with echocardiography has several known limitations 4 that can affect this estimation and critically influence the estimation of the LV pressure curve; (2) the method was derived from a small cohort of patients with moderate and severe AS from a single center and was not externally validated; (3) and finally, in the current form, the mathematical model is quite cumbersome to use in routine clinical practice and implement in any commercially available software. It would be important to validate the results by Owashi et al 3 in other groups of patients with severe AS.Importantly, another very recent publication by Jain et al 5 used the same method applied in our study 2 to derive LV MW indices in 35 patients with severe AS undergoing transcatheter aortic valve replacement (TAVR). In this study, while LV GLS improved after TAVR (from À14% 6 4% to À15% 6 3%, P = .020), LV global work index decreased (from 1,856 6 705 mm Hg% to 1,535 6 385 mm Hg%, P < .001) and global work efficiency remained relatively stable (from 88.7% 6 11.9% to 89.9% 6 5.9%, P = .498). The differences in the trend of these parameters of LV function after TAVR highlight, as much as our study, 2 the importance of correcting for LV afterload when assessing the LV performance in patients with severe AS. Although our study and the study by Jain et al 5 provided encouraging results on the potential utility of the echocardiography-based calculation of LV MW indices in severe AS, further data would be needed to investigate their clinical value and particularly their role in risk stratification of patients with severe AS, compared with the parameters recommended by current guidelines.

Echocardiographic correlates of major adverse cardiac events at 1 year in patients with apical ballooning takotsubo syndrome

“…A recent small study found clinically significant differences when patients with TTS were stratified by GLS recovery. 27 However, there were no differences in subsequent hospitalization and mortality between the groups in a short follow-up. When stratifying patients based on normalization of LVEF (>53%) or GLS (>18%), we found that a normalized GLS at follow-up was better able to discriminate prognosis in patients with TTS than LVEF.…”

“…A recent small study found clinically significant differences when patients with TTS were stratified by GLS recovery 27 . However, there were no differences in subsequent hospitalization and mortality between the groups in a short follow‐up.…”