Assessment of Cardiac Chamber Sizes in Acute Phase Takotsubo Cardiomyopathy Compared to Acute Anterior Myocardial Infarction

Abstract

Background: The ECG and clinical findings of Takotsubo cardiomyopathy (TCM) and acute myocardial infarction (AMI) can be very similar. However, the regional wall motion abnormalities seen in TCM are pathognomonic and different to AMI. Dilatation of cardiac chambers have been described post AMI, including dilatation of the left atrium (LA) which has been shown to have prognostic value. The aim of our study was to determine if similar changes in the size of cardiac chambers occurred during the acute phase of TCM as seen post AMI. Methods: Consecutive patients with TCM presenting to our institution were compared to age and LVEF matched patients with acute anterior ST-segment elevation myocardial infarction (STEMI), a major differential diagnosis of TCM. A range of echocardiographic variables quantifying left and right heart chamber size and function were examined from transthoracic echocardiograms performed within 48 hours of presentation and compared between the cohorts. Results: 14 consecutive patients with TCM (mean age 68.4 ± 13.7 years; 100% female) were compared to 14 patients with an anterior STEMI (67.2 ± 13.9 years; 57% female). Patients with acute anterior STEMIs demonstrated significantly higher indexed left ventricular (LV) volumes compared to TCM patients despite no significant difference in systolic function. Interestingly, the indexed left atrial volume (LAVi) was also higher in patients with acute infarcts compared to TCM. Conclusion: Despite characteristic regional wall motion abnormalities seen with TCM, there does not appear to be a significant increase in the left and right ventricular volumes or left atrial size compared to acute infarct patients.Tabled 1TCMSTEMISignificance(p value)Age (years)68.4 ± 1367.2 ± 13.90.83Females, n (%)14 (100%)8 (57%)0.016LVEF (%)44 ± 9.944 ± 9.60.99LV end diastolic diameter (mm/m2)27 ± 528 ± 70.61LV end systolic diameter (mm/m2)19 ± 420 ± 60.49LV end diastolic volume (ml/m2)47 ± 1369 ± 260.01LVend systolic volume (ml/m2)27 ± 942 ± 230.04E/A1.1 ± 0.41.1 ± 0.40.84Average E/e’12.2 ± 3.016.5 ± 7.80.08LA volume indexed (ml/m2)34 ± 947 ± 200.043Right atrial area (cm2)14 ± 315 ± 50.61RV basal diameter (mm)30 ± 433 ± 40.045RVS’ (m/s)11.8 ± 3.211.8 ± 2.70.96 Open table in a new tab