256 LEFT ATRIAL STRAIN ANALISIS IMPROVES NON-INVASIVE ESTIMATION OF LEFT VENTRICULAR FILLING PRESSURES IN TAKOTSUBO SYNDROME

Abstract

Abstract Background Takotsubo syndrome (TTS) is associated with a non-negligible risk of in-hospital complications. Elevated left ventricular filling pressures (LVFP) showed to predict adverse outcomes in this population. Recently, LA reservoir and LA pump strain, demonstrated a close correlation with increased LVFP in unselected patients. The aim of our study is to assess the ability of LA strain analysis to improve non-invasive estimation of LVFP and to predict IH complications in TTS patients. Methods We prospectively enrolled patients with confirmed TTS diagnosis. LVEDP was assessed invasively at the time of catheterization. Transthoracic echocardiography was performed within 48 hours from hospital admission. In-hospital complications were collected, including occurrence of acute heart failure, death from any cause and life-threatening arrhythmias. Results A total of 62 patients were analysed (72.2±10.1 years, female 80%). In-hospital complications occurred in 25 (40.3%). Patients who experienced IH complications had higher LVEDP and lower LVEF, LA reservoir strain and LA pump strain values compared to patients without IH complications (all p<0.001). However, at multivariate analysis, only LVEF and LVEDP were independent predictors of worse IH outcomes (p<0.001 and p=0.004, respectively). We observed that in our population the optimal LVEDP cut-off value to predict adverse in-hospital outcome was 24.5 mmHg (sensitivity 80%, specificity 63%). LA reservoir and pump strain resulted to be better predictors of LVEDP >24.5 mmHg in comparison with E/e’, LAVi and tricuspid regurgitation (TR) peak velocity. Moreover, the incorporation of LA strain values in a multivariable model including E/e’ ratio, LAVi and TR peak velocity to predict a LVEDP>24.5 mmHg led to a significant incremental predictive value (p=0.002). Conclusion In patients with TTS, lower LA reservoir and pump strain values correlate with increased LVEDP and improve non-invasive estimation of LVFP. LA strain analysis may be an easy tool to individuate subjects at higher risk of in-hospital complications.