Left atrial function is transiently impaired in tako-tsubo cardiomyopathy: A prospective study using left atrial two-dimensional longitudinal strain

Abstract

Takotsubo cardiomyopathy (TTC) is a distinct clinical entity characterized by the presence of transient left ventricular (LV) wall motion abnormalities without significant culprit obstructive coronary artery disease. Whether left atrial (LA) function is also transiently impaired in this setting is unclear. To assess prospectively the LA function by two-dimensional longitudinal strain at the acute phase of TTC and after recovery. Thirty-seven consecutive patients satisfying the criteria for typical TTC (mean age 79 ± 9 years, 34 women) underwent transthoracic-Doppler echocardiography at the acute phase and at follow-up (on average 30 days later), including the measurement of the LA peak systolic longitudinal strain (LAS) which was measured as a mean of maximal strain from the 4–2 chamber views conducted using a dedicated software package, using R-R gating. A control group of 8 patients (76 ± 7 years, 7 women) without overt cardiovascular disease served as a comparative group. In the TTC group, LAS improved significantly between the two examinations from 15.5 ± 6% to 27 ± 9% ( P < 0.01) whereas LA volume did not change (from 30 ± 13 to 29 ± 12 ml/m 2 , P = NS). By comparison, in the control group LAS was 30 ± 3% ( P < 0.01 vs. TTC acute phase, P = NS vs. TTC follow-up) and LA volume/m 2 was 28 ± 3.5 ( P = NS vs. TTC all phases). The change of LAS in the TTC group (median improvement 62%, 25 th -75 th percentiles: 18–129%) was significantly correlated to the change of the global LV longitudinal strain ( r = −0.41, P = 0.01). Serial measurements of LAS suggests transient impairment of LA function (reservoir) at the acute phase of TTC. Furthermore, the improvement of LAS parallel the dynamic improvement of LV systolic function.