Skip to main content
SpringerLink
Log in

The left atrial function is transiently impaired in Tako-tsubo cardiomyopathy and associated to in-hospital complications: a prospective study using two-dimensional strain

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Tako-tsubo cardiomyopathy (TTC) is characterized by the presence of transient left ventricular (LV) dysfunction. Whether left atrial (LA) function is also impaired in this setting is unclear. To assess prospectively LA peak systolic longitudinal strain (LAS) by two-dimensional strain at the acute phase of TTC and after recovery and its association with in-hospital complications. 40 patients with typical TTC (mean age 79.5 ± 10 years) underwent transthoracic-Doppler echocardiography at the acute phase and at follow-up (32 ± 18 days later), including the measurement of the LAS (mean of maximal strain from the 4–2 chamber views). A control group of 15 patients (75 ± 7 years, 13 women) without overt cardiovascular disease served as a comparative group. In-hospital complication was a composite of death, heart failure, cardiogenic shock, LV thrombus, and sustained ventricular arrhythmia. In the TTC group, LAS improved significantly between the two examinations from 15 ± 5.5% to 27 ± 8% (p < 0.01) whereas LA volume did not change (p = NS). In the control group LAS was 30 ± 4% (p < 0.01 vs. TTC acute phase, p = NS vs. TTC follow-up). In TTC, at the acute phase LAS was independently correlated to LV global longitudinal strain (LVGLS), and after recovery to E/e′, and the change of LAS was independently correlated to the change of the LVGLS (all, p < 0.01). Furthermore LAS was independently correlated to in-hospital complications (p < 0.01). LA function (reservoir) is transiently impaired in TTC and associated to in-hospital complications. Furthermore, the improvement of LAS parallel the dynamic improvement of LVGLS suggests that TTC induces a transient global left heart dysfunction.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Kurisu S, Sato H, Kawagoe T, Ishihara M, Shimatani Y, Nishioka K et al (2002) Tako-tsubo-like left ventricular dysfunction with ST-segment elevation: a novel cardiac syndrome mimicking acute myocardial infarction. Am Heart J 143:448–455

    Article  Google Scholar 

  2. Ghadri J-R, Wittstein IS, Prasad A, Sharkey S, Dote K, Akashi YJ et al (2018) international expert consensus document on Takotsubo syndrome (Part I): clinical characteristics, diagnostic criteria, and pathophysiology. Eur Heart J 39:2032–2046

    Article  Google Scholar 

  3. Citro R, Rigo F, Previtali M, Ciampi Q, Canterin FA, Provenza G et al (2012) Differences in clinical features and in-hospital outcomes of older adults with tako-tsubo cardiomyopathy. J Am Geriatr Soc 60:93–98

    Article  Google Scholar 

  4. Meimoun P, Abouth S, Boulanger J, Luycx-Bore A, Martis S, Clerc J (2014) Relationship between acute strain pattern and recovery in tako-tsubo cardiomyopathy and acute anterior myocardial infarction: a comparative study using two-dimensional longitudinal strain. Int J Cardiovasc Imaging 30:1491–1500

    Article  Google Scholar 

  5. Meimoun P, Djebali M, Botoro T, Djou U, Bidounga H, Elmkies F et al (2019) Left atrial strain and distensibility in relation to left ventricular dysfunction and prognosis in aortic stenosis. Echocardiography 00:1–9. https://doi.org/10.1111/echo.14258

    Article  Google Scholar 

  6. Mansencal N, Abbou N, Pillière R, El Mahmoud R, Farcot J-C, Dubourg O (2009) Usefulness of two-dimensional speckle tracking echocardiography for assessment of tako-tsubo cardiomyopathy. Am J Cardiol 103:1020–1024

    Article  Google Scholar 

  7. Citro R, Lyon AR, Meimoun P, Omerovic E, Redfors B, Buck T et al (2015) Standard and advanced echocardiography in Takotsubo (stress) cardiomyopathy: clinical and prognostic implications. J Am Soc Echocardiogr 28:57–74

    Article  Google Scholar 

  8. Heggemann F, Weiss C, Hamm K, Kaden J, Süselbeck T, Papavassiliu T et al (2009) Global and regional myocardial function quantification by two-dimensional strain in Takotsubo cardiomyopathy. Eur J Echocardiogr 10:760–764

    Article  Google Scholar 

  9. Meimoun P, Passos P, Benali T, Boulanger J, Elmkies F, Zemir H et al (2011) Assessment of left ventricular twist mechanics in Tako-tsubo cardiomyopathy by two-dimensional speckle-tracking echocardiography. Eur J Echocardiogr J 12:931–939

    Article  Google Scholar 

  10. Schwarz K, Ahearn T, Srinivasan J, Neil CJ, Scally C, Rudd A et al (2017) Alterations in cardiac deformation, timing of contraction and relaxation, and early myocardial fibrosis accompany the apparent recovery of acute stress-induced (Takotsubo) cardiomyopathy: an end to the concept of transience. J Am Soc Echocardiogr 30:745–755

    Article  Google Scholar 

  11. Morris DA, Takeuchi M, Krisper M, Köhncke C, Bekfani T, Carstensen T et al (2015) Normal values and clinical relevance of left atrial myocardial function analysed by speckle-tracking echocardiography: multicentre study. Eur Heart J Cardiovasc Imaging 16:364–372

    Article  Google Scholar 

  12. Vianna-Pinton R, Moreno CA, Baxter CM, Lee KS, Tsang TSM, Appleton CP (2009) Two-dimensional speckle-tracking echocardiography of the left atrium: feasibility and regional contraction and relaxation differences in normal subjects. J Am Soc Echocardiogr 22:299–305

    Article  Google Scholar 

  13. Cameli M, Mandoli GE, Loiacono F, Dini FL, Henein M, Mondillo S (2016) Left atrial strain: a new parameter for assessment of left ventricular filling pressure. Heart Fail Rev 21:65–76

    Article  Google Scholar 

  14. Cameli M, Caputo M, Mondillo S, Ballo P, Palmerini E, Lisi M et al (2009) Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking. Cardiovasc Ultrasound 7:6. https://doi.org/10.1186/1476-7120-7-6

    Article  PubMed  PubMed Central  Google Scholar 

  15. Cameli M, Lisi M, Focardi M, Reccia R, Natali BM, Sparla S et al (2012) Left atrial deformation analysis by speckle tracking echocardiography for prediction of cardiovascular outcomes. Am J Cardiol 110:264–269

    Article  Google Scholar 

  16. Lang RM, Badano LP, Mor-Avi V, Afilalo J, Armstrong A, Ernande L et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr 28:1–39

    Article  Google Scholar 

  17. Templin C, Ghadri JR, Diekmann J, Napp LC, Bataiosu DR, Jaguszewski M et al (2015) Clinical features and outcomes of Takotsubo (stress) cardiomyopathy. N Engl J Med 373:929–938

    Article  CAS  Google Scholar 

  18. Haghi D, Athanasiadis A, Papavassiliu T, Suselbeck T, Fluechter S, Mahrholdt H et al (2006) Right ventricular involvement in Takotsubo cardiomyopathy. Eur Heart J 27:2433–2439

    Article  Google Scholar 

  19. Burri MV, Nanda NC, Lloyd SG, Hsiung MC, Dod HS, Beto RJ et al (2008) Assessment of systolic and diastolic left ventricular and left atrial function using vector velocity imaging in Takotsubo cardiomyopathy. Echocardiography 25:1138–1144

    Article  Google Scholar 

  20. Backhaus SJ, Stiermaier T, Lange T, Chiribiri A, Uhlig J, Freund A et al (2019) Atrial mechanics and their prognostic impact in Takotsubo syndrome: a cardiovascular magnetic resonance imaging study. Eur Heart J Cardiovasc Imaging 20:1059–1069

    Article  Google Scholar 

  21. O’Connor K, Magne J, Rosca M, Piérard LA, Lancellotti P (2010) Impact of aortic valve stenosis on left atrial phasic function. Am J Cardiol 106:1157–1162

    Article  Google Scholar 

  22. Smiseth OA, Torp H, Opdahl A, Haugaa KH, Urheim S (2016) Myocardial strain imaging: how useful is it in clinical decision making? Eur Heart J 37:1196–1207

    Article  Google Scholar 

  23. Miglioranza MH, Badano LP, Mihaila S, Peluso D, Cucchini U, Soriani N et al (2016) Physiologic determinants of left atrial longitudinal strain: a two-dimensional speckle-tracking and three dimensional echocardiographic study in healthy volunteers. J Am Soc Echocardiogr 29:1023–1034

    Article  Google Scholar 

  24. Galli E, Fournet M, Chabanne C, Lelong B, Lequerrier A, Flecher E et al (2016) Prognostic value of left atrial reservoir function in patients with severe aortic stenosis: a 2D speckle-tracking echocardiographic study. Eur Heart J Cardiovasc Imaging 17:533–541

    Article  CAS  Google Scholar 

  25. Todaro MC, Carerj S, Khandheria B, Cusmà-Piccione M, Carrubba SL, Antonini-Canterin F et al (2016) Usefulness of atrial function for risk stratification in asymptomatic severe aortic stenosis. J Cardiol 67:71–79

    Article  Google Scholar 

  26. Cameli M, Lisi M, Righini FM, Massoni A, Natali BM, Focardi M et al (2013) Usefulness of atrial deformation analysis to predict left atrial fibrosis and endocardial thickness in patients undergoing mitral valve operations for severe mitral regurgitation secondary to mitral valve prolapse. Am J Cardiol 111:595–601

    Article  Google Scholar 

  27. Mondillo S, Cameli M, Caputo ML, Lisi M, Palmerini E, Padeletti M et al (2011) Early detection of left atrial strain abnormalities by speckle tracking in hypertensive and diabetic patients with normal left atrial size. J Am Soc Echocardiogr 24:898–908

    Article  Google Scholar 

  28. O’Connor K, Magne J, Rosca M, Piérard LA, Lancellotti P (2011) Left atrial function and remodeling in aortic stenosis. Eur J Echocardiogr 12:299–305

    Article  Google Scholar 

  29. Genovese D, Singh A, Volpato V, Kruse E, Weinert L, Yamat M et al (2018) Load dependency of left atrial strain in normal subjects. J Am Soc Echocardiogr 31:1221–1228

    Article  Google Scholar 

  30. Singh A, Medvedovsky D, Mediratta A, Balaney B, Kruse E, Ciszek B et al (2019) Peak left atrial strain as a single measure for the non-invasive assessment of left ventricular filling pressures. Int J Cardiovasc Imaging 35:23–32

    Article  Google Scholar 

  31. Oliveira MS, Carmona F, Vicente WVA, Manso PH, Mata KM, Celes MR et al (2017) Increased atrial β-adrenergic receptors and GRK-2 gene expression can play a fundamental role in heart failure after repair of congenital heart disease with cardiopulmonary bypass. Pediatr Cardiol 38:734–745

    Article  Google Scholar 

  32. Doggrell SA, Surman AJ (1994) Functional beta-adrenoceptors in the left atrium of normotensive and hypertensive rats. J Auton Pharmacol 14:425–436

    Article  CAS  Google Scholar 

  33. Freed BH, Daruwalla V, Cheng JY, Aguilar FG, Beussink L, Choi A et al (2016) Prognostic utility and clinical significance of cardiac mechanics in heart failure with preserved ejection fraction. Circ Cardiovasc Imaging 9:e003754. https://doi.org/10.1161/CIRCIMAGING.115.003754

    Article  PubMed  Google Scholar 

  34. Pathan FP, Sivaraj E, Negishi K, Rafiuden R, Pathan S, D’Elia N et al (2018) Use of atrial strain to predict atrial fibrillation after cerebral ischemia. J Am Coll Cardiol Img 11:1557–1565

    Article  Google Scholar 

  35. Sugimoto T, Robinet S, Dulgheru R, Bernard A, Ilardi F, Contu L et al (2018) Echocardiographic reference ranges for normal left atrial function parameters: results from the EACVI NORRE study. Eur Heart J Cardiovasc Im 19:630–638

    Article  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Cardiology, Centre Hospitalier de Compiègne, Compiègne Hospital, 8 rue Henri Adnot, 60200, Compiègne, France

    P. Meimoun, V. Stracchi, J. Boulanger, S. Martis, T. Botoro, H. Zemir & J. Clerc

Authors
  1. P. Meimoun
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. V. Stracchi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. J. Boulanger
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. S. Martis
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. T. Botoro
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. H. Zemir
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. J. Clerc
    View author publications

    You can also search for this author in PubMed Google Scholar

Contributions

All authors contributed to the study and approved the manuscript.

Corresponding author

Correspondence to P. Meimoun.

Ethics declarations

Conflict of interest

All the authors declares that they have no conflict of interest.

Ethical approval

The study have been approved by the local ethics committee and have been performed in accordance with the ethical standards as laid down in the 1964 Declaration of Helsinki and its later amendments or comparable ethical standards.

Informed consent

Inform consent was obtained from all patients included in the study.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Meimoun, P., Stracchi, V., Boulanger, J. et al. The left atrial function is transiently impaired in Tako-tsubo cardiomyopathy and associated to in-hospital complications: a prospective study using two-dimensional strain. Int J Cardiovasc Imaging 36, 299–307 (2020). https://doi.org/10.1007/s10554-019-01722-6

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-019-01722-6

Keywords

Search

Navigation