Myocardial dysfunction in Takotsubo syndrome: More than meets the eye?
| Autor: | M. Júlia Maciel, Vânia Ribeiro, Roberto Pinto, Mariana Vasconcelos, Filipe Macedo, Gonçalo Pestana, Pedro Bernardo Almeida, Marta Tavares-Silva, Carla A. Sousa |
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| Rok vydání: | 2019 |
| Předmět: |
Adult
Male lcsh:Diseases of the circulatory (Cardiovascular) system medicine.medical_specialty Systole Heart Ventricles Population Ventricular Function Left Coronary artery disease Electrocardiography 03 medical and health sciences Basal (phylogenetics) 0302 clinical medicine Takotsubo Cardiomyopathy Internal medicine Humans Medicine 030212 general & internal medicine Myocardial infarction education Aged Retrospective Studies General Environmental Science Aged 80 and over education.field_of_study Takotsubo syndrome Ejection fraction business.industry Middle Aged medicine.disease Pathophysiology 030228 respiratory system Echocardiography lcsh:RC666-701 Cardiology General Earth and Planetary Sciences Female Anterior Wall Myocardial Infarction Cardiomyopathies Cardiology and Cardiovascular Medicine business |
| Zdroj: | Revista Portuguesa de Cardiologia (English Edition), Vol 38, Iss 4, Pp 261-266 (2019) Revista Portuguesa de Cardiologia, Vol 38, Iss 4, Pp 261-266 (2019) |
| ISSN: | 0870-2551 |
| Popis: | Introduction: Takotsubo syndrome (TTS) is characterized by transient left ventricular (LV) dysfunction, typically mimicking an anterior wall myocardial infarction (MI), without obstructive coronary artery disease. In the few published reports assessing myocardial deformation in TTS and MI, no consistent differences have been described between the two entities. We sought to characterize global and regional function in TTS and to compare it with a population with MI. Methods: Clinical data, including echocardiography, were gathered from 17 TTS patients and 20 anterior wall ST-segment elevation myocardial infarction (STEMI) controls. Peak systolic longitudinal strain was determined for each LV segment using speckle tracking imaging, and global and mean apical, midventricular and basal longitudinal strain were calculated from these. Results: Both TTS and STEMI patients presented significant LV systolic dysfunction, and there were no significant differences in ejection fraction or global longitudinal strain. Regional longitudinal strain was more severely impaired in basal inferolateral and mid anterolateral segments in the TTS group and in apical anteroseptal segments in the STEMI group. Mean longitudinal strain was worse in the basal segments of TTS patients (-9.8±2.9 vs. -12.4±4.1%, p=0.010), with no significant differences in mid and apical segments. The basal/apical ratio was significantly lower in this group as well (1.51±0.86 vs. 2.94±1.88, p=0.006). Conclusions: While both TTS and STEMI feature significantly impaired global systolic function, we found a regional pattern of worse basal longitudinal strain and a lower basal/apical ratio in the former. These suggest generalized myocardial impairment in TTS, providing new clues about its pathophysiology and possible specific echocardiographic changes. Resumo: Introdução: A síndrome de Takotsubo (TTS) é caracterizada por disfunção ventricular esquerda transitória, habitualmente simulando um enfarte agudo do miocárdio (STEMI) anterior, sem doença coronária obstrutiva. Nos poucos trabalhos publicados avaliando deformação miocárdica não estão descritas diferenças consistentes entre as duas entidades. Procurámos caracterizar a função global e regional na TTS e compará-la com uma população com STEMI. Métodos: Reunimos dados clínicos, incluindo ecocardiográficos, de 17 doentes com TTS e 20 controlos com STEMI anterior. O pico sistólico de strain longitudinal foi determinado para cada segmento ventricular usando speckle tracking; a partir destes calculou-se o strain longitudinal global e a média dos segmentos apicais, médios e basais. Resultados: Tanto os doentes com TTS como STEMI apresentaram disfunção sistólica ventricular esquerda importante, sem diferença significativa da fração de ejeção e strain longitudinal global. O strain regional foi pior nos segmentos basal inferolateral e médio anterolateral do grupo com TTS e no apical anteroseptal dos doentes com STEMI. O strain longitudinal médio dos segmentos basais foi pior nos doentes com TTS (-9,8 ± 2,9 versus -12,4 ± 4,1%, p=0,010), sem diferença significativa nos médios ou apicais. A razão basal/apical também foi mais baixa neste grupo (1,51±0,86 versus 2,94±1,88, p=0,006). Conclusões: Apesar de tanto a TTS como o STEMI apresentarem disfunção sistólica global importante, encontrámos um padrão de pior strain longitudinal basal e uma razão basal/apical mais baixa nos primeiros. Isto sugere uma disfunção miocárdica generalizada na TTS e fornece novas pistas relativamente à sua fisiopatologia e possíveis alterações ecocardiográficas específicas. Keywords: Takotsubo cardiomyopathy, Echocardiography, Myocardial deformation, Palavras-chave: Miocardiopatia de Takotsubo, Ecocardiografia, Deformação miocárdica |
| Databáze: | OpenAIRE |
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