Abstract 14726: Right Ventricular Strain Analysis May Be Useful in Differentiating Takotsubo Cardiomyopathy From Left Anterior Descending Coronary Artery Disease
Background: Takotsubo cardiomyopathy (TTC) is a transient form of left ventricular (LV) dysfunction triggered by significant physiological stress and associated with a distinctive pattern of regional LV dysfunction on echocardiography. This pattern can be similar to and therefore difficult to differentiate from that seen in left anterior descending coronary artery (LAD) occlusion. We hypothesized that right ventricular (RV) involvement as detected by RV free-wall longitudinal strain (FWLS) might help differentiating TCC from LAD infarction.
Methods: 44 patients with TTC and 36 with LAD infarct were studied. The RV focused view was used to measure TAPSE (M-mode), S’ (pulsed-wave Doppler), and fractional area change (FAC). RVFWLS was measured offline (Epsilon). Apical 2-, 3- and 4-chamber views were used to measure LV longitudinal strain (LS) (QLAB) and biplane Simpsons was used to assess LV ejection fraction (EF).
Results: LVEF was 31±10% in TTC and 41±9% in the LAD group. There was no significant difference in global LV LS between the two groups. Regional differences were noted with lower strain values in the mid and apical inferior, posterior and lateral segments in TTC. RV FAC, TAPSE, and S’ were lower in the TTC group than the LAD group. Overall RV FWLS was significantly lower in TTC than LAD infarct group (-18±8 vs -23±6%, p<0.05). This was due to marked reduction in apical LS (-10±8 vs -15±7%; p=0.002) with no significant differences in mid and basal LS (-19±11 vs -23±9% and -26±13 vs -30±12%, respectively). ROC analysis showed apical RVFWLS to be the best predictor for TTC with area under the curve (AUC) 0.73 (Fig).
Conclusion: The regional pattern of RV dysfunction as assessed by FWLS revealed predominately reduction in the apical segments, and sparing of function in the mid and basal segments. Our results suggest that RV involvement should be more carefully evaluated in clinical practice when TTC is suspected as it may help differentiate this condition from LAD disease.
Author Disclosures: L. Cai: None. K. Addetia: None. V. Mor-Avi: None. K. Spencer: None.
- © 2015 by American Heart Association, Inc.