Evaluation of myocardial work index in predicting in-hospital complication in patients with Takotsubo syndrome

Abstract

Abstract Funding Acknowledgements Type of funding sources: None. Backgrounds Tako-tsubo syndrome (TTS) is a reversible heart failure pathology characterized by transient myocardial left ventricular (LV) dysfunction. Although traditionally considered a benign condition, in-hospital complications are frequent in this cohort of patients. Non-invasive myocardial work (MW) parameters are considered as emerging indexes in evaluating global and regional myocardial systolic function. Aim The aim of this TTS study was to investigate the potential association of MW with in-hospital complications, and to compare MW with standard (LVEF) and advanced (GLS) echocardiographic parameters of LV systolic function Methods thirty-eight patients (mean age, 68 ± 12 years, 35 women) with TTS diagnosed with Takotsubo Italian Network criteria were prospectively enrolled and underwent a transthoracic Doppler echocardiography within 24 hours from hospital admission. Clinical and echocardiographic characteristics during the index event were reported in table 1. MW is derived from the non-invasive strain-pressure loop obtained from the 2D strain data, integrating into its calculation the non-invasive brachial arterial pressure. Constructive MW (CMW), MW index (MWI), MW efficiency (MWE), and wasted myocardial work (WMW) were measured. LV GLS and LV EF were also measured. In hospital complications were defined as a composite of apical LV thrombosis, hypokinetic arrhythmias (HA), supraventricular tachycardia (SVT), acute heart failure (AHF), ventricular tachycardia/fibrillation (VT/VF), cardiogenic shock (CS), respiratory arrest (RA), stroke and cardiac death (CD). Results Hospital complications occurred in 16 TTS patients (26% with AHF; 10% with SVT; 8% with CS; 5% with apical LV thrombosis; 5% with HA; 2,6 % with RA; 2,6% with stroke; 2% with VT/VF). The WMW parameter appear to have the best performance in predicting in-hospital complications (odds ratio for having HC: 8.4 (95% confidence interval: 1.5 to 46.1), figure 2). Conclusion global and regional myocardial performance is transiently impaired in TTS and significantly associated with hospital complication. Although limited by the low number of patients, these results suggest that myocardial work parameters may have a better performance than the EF value in predicting intra-hospital complications. Larger studies will be necessary to confirm these preliminary results.