Abstract 15160: Prognostic Value of Left Ventricular Strain in Takotsubo Syndrome
Introduction: Takotsubo syndrome (TTS) is a peculiar condition resembling an acute coronary syndrome and mostly affecting postmenopausal women after a stressful trigger. TTS was initially thought to be benign however current data has shown it may be associated with inpatient morbidity and carry a small, but important, mortality risk.
Hypothesis: We hypothesized that left ventricular (LV) global longitudinal strain (GLS), assessed by speckle tracking could distinguish those at greatest risk for in-hospital cardiovascular events.
Methods: We conducted a retrospective descriptive study reviewing patients with the discharge diagnosis of TCM between 2003-2015. 99 TSS patients met the Modified Mayo Clinic criteria. Using speckle-tracking echocardiography, 2 independent cardiologists assessed the LV GLS and he longitudinal strain (LS) of 7 individual segments [basal-septal (BS); mid-septal (MS), apical-septal (AS), apex, basal-lateral (BL), mid-lateral (ML) and apical-lateral (AL)]. The inter-observer variability was < 5%.
Results: Mean age was 69 years, 87% were females and 53% were African Americans. Mean initial LV ejection fraction was 32% ± 10%. Table 1 shows segmental LS means. In univariate analysis, patients with worse BL, ML and GLS profiles (means: -5.6; -3.3 and -4 respectively) had higher in-hospital mortality (p < 0.05). Worse BL and ML profiles (means: -8.2 and -7.2 respectively) were associated with higher prevalence of major adverse cardiovascular outcomes (MACE; p < 0.05). In a multivariate analysis BL and ML remained independent predictors of in-hospital mortality and MACE. ML worse than -7 and BL worse than -8 had sensitivities of 90% and 70%, respectively, in predicting mortality during the index admission.
Conclusions: Assessment of LV global and segmental longitudinal strain by speckle tracking may have important prognostic value in the acute phase of TTS. Additional
large-scale studies will be needed to confirm our findings.
Author Disclosures: A. Dias: None. M. Rubio: None. E. Franco: None. V. Bhalla: None. P. Krishnamoorthy,: None. G. Pressman: None. K. Hebert: None. V.M. Figueredo: None.
- © 2016 by American Heart Association, Inc.