IntroductionTakotsubo cardiomyopathy (TC) is an acute heart failure syndrome. Although left ventricular ejection fraction (LVEF) often improves, TC leads to significant morbidity and mortality in select patients. Two-dimensional speckle tracking strain echocardiography measures myocardial deformation, a sensitive marker for myocardial dysfunction. We sought to evaluate the utility of changes in myocardial strain to predict mortality in TC.HypothesisWe hypothesized that temporal changes in strain values will predict mortality in TC better than change in LVEF.MethodsWe retrospectively identified patients with TC based on ICD9/10 codes at a single center between 2006-2017. Two-dimensional echocardiography was used to measure LVEF and speckle tracking strain echocardiography was used to measure global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) with TomTec Arena software version 2.21. Measurements from presentation and follow-up echocardiograms were obtained. Absolute differences in values between echocardiograms was also determined. A multivariable Cox proportional hazards model evaluated association with time to all-cause mortality within 1 year.ResultsWe identified 192 patients with mean age 66.4 +/− 14.8 years, 78% women, and 62% white. Within 1 year, 33 (17%) deaths occurred. A multivariate analysis showed LVEF, GLS, GCS, and GRS at presentation were not significantly associated with time to all-cause mortality (Table 1). A subgroup analysis of 102 patients with a follow-up echocardiogram (median 16.5 days later) assessed change in LVEF and strain. There were 14 deaths (14%) in the subgroup. A multivariate analysis showed absolute change in GLS and GCS values were significantly associated with time to all-cause mortality, whereas LVEF and GRS were not (Table 2).ConclusionIn this single-center, retrospective study, LVEF and strain at presentation were not associated with mortality. However, lack of improvement in GLS and GCS was associated with increased risk of mortality. This finding demonstrates the utility of strain echocardiography in TC, as changes in strain were a better predictor of adverse outcomes than LVEF at presentation, changes in LVEF, and strain measurements at baseline. Takotsubo cardiomyopathy (TC) is an acute heart failure syndrome. Although left ventricular ejection fraction (LVEF) often improves, TC leads to significant morbidity and mortality in select patients. Two-dimensional speckle tracking strain echocardiography measures myocardial deformation, a sensitive marker for myocardial dysfunction. We sought to evaluate the utility of changes in myocardial strain to predict mortality in TC. We hypothesized that temporal changes in strain values will predict mortality in TC better than change in LVEF. We retrospectively identified patients with TC based on ICD9/10 codes at a single center between 2006-2017. Two-dimensional echocardiography was used to measure LVEF and speckle tracking strain echocardiography was used to measure global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS) with TomTec Arena software version 2.21. Measurements from presentation and follow-up echocardiograms were obtained. Absolute differences in values between echocardiograms was also determined. A multivariable Cox proportional hazards model evaluated association with time to all-cause mortality within 1 year. We identified 192 patients with mean age 66.4 +/− 14.8 years, 78% women, and 62% white. Within 1 year, 33 (17%) deaths occurred. A multivariate analysis showed LVEF, GLS, GCS, and GRS at presentation were not significantly associated with time to all-cause mortality (Table 1). A subgroup analysis of 102 patients with a follow-up echocardiogram (median 16.5 days later) assessed change in LVEF and strain. There were 14 deaths (14%) in the subgroup. A multivariate analysis showed absolute change in GLS and GCS values were significantly associated with time to all-cause mortality, whereas LVEF and GRS were not (Table 2). In this single-center, retrospective study, LVEF and strain at presentation were not associated with mortality. However, lack of improvement in GLS and GCS was associated with increased risk of mortality. This finding demonstrates the utility of strain echocardiography in TC, as changes in strain were a better predictor of adverse outcomes than LVEF at presentation, changes in LVEF, and strain measurements at baseline.