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Evolution of non-invasive myocardial work in tako-tsubo cardiomyopathy

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Abstract

Tako-tsubo cardiomyopathy (TTC) is characterized by left ventricular (LV) systolic dysfunction with transient wall motion abnormalities (WMA). However, whether systolic performance fully recovers is unclear. Non-invasive myocardial work (MW) is a new tool to assess the LV performance, never described in this setting. To assess MW in apical TTC. Fifty patients with the apical variant TTC (77 ± 10 years, 47 women) were enrolled and underwent a transthoracic echocardiography within 24 h of admission and a median of 36 days at follow-up (FU). Constructive work (CW), wasted work (WW), MW index (MWI) and efficiency (MWE) were derived from a strain- pressure loop obtained from non-invasive brachial blood pressure and 2D strain. Hospital complications (HC) were defined as heart failure, LV apical thrombus, and ventricular arrhythmia. A control group of 24 matched-subjects was used. Myocardial work improved significantly between the acute phase and follow-up (global, and all apical and middle segments for all indices, all, p < 0.01; and some basal segments for MWI and CW, all p < 0.05). The degree of impairment of MW followed an apical-basal gradient (worse in apical segments), which inverted at follow-up. Furthermore, in TTC, global CW and MWI were significantly impaired in patients with HC (n = 10, all p < 0.05). At follow-up, global and regional MW remained significantly reduced by comparison to the control group (CW, MWI, MWE, WW, all p < 0.01), despite similar hemodynamics, LVEF and 2D-strain (all, p = NS). Myocardial work is transiently altered in apical TTC and significantly associated to HC. Despite total recovery of WMA, subtle dysfunction of myocardial performance persists at FU.

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Abbreviations

TTC:

Tako-tsubo cardiomyopathy

WMA:

Wall motion abnormalities

TDE:

Transthoracic Doppler echocardiography

AVC:

Aortic valve closure

LV:

Left ventricle

GLS:

Global longitudinal strain

LVEF:

Left ventricular ejection fraction

MRI:

Magnetic resonance imaging

MW:

Myocardial work

CMW:

Constructive myocardial work

MWI:

Myocardial work index

MWE:

Myocardial work efficiency

WW:

Wasted work

g:

Global

r:

Regional

s:

Segmental

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Funding

The authors declare that no funds, grants, or other support were received during the preparation of this manuscript.

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Author notes

  1. P. Meimoun, A. Vernier contributed equally to the work.

Authors and Affiliations

  1. Department of Cardiology and Intensive Care Unit, Centre Hospitalier de Compiègne, 8 rue Henri Adnot, 60200, Compiègne, France

    P. Meimoun, A. Vernier, P. Lachambre, V. Stracchi & J. Clerc

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  1. P. Meimoun
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  2. A. Vernier
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  4. V. Stracchi
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Contributions

All authors contributed to the study conception and design. Material preparation, data collection and analysis were performed by [AV], [PM] and [JC]. The first draft of the manuscript was written by [PM] and all authors commented on previous versions of the manuscript. All authors read and approved the final manuscript.”

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Correspondence to P. Meimoun.

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This is an observational study. The local Ethics Committee has confirmed that no ethical approval is required.

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Informed consent was obtained from all individual participants included in the study.

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Meimoun, P., Vernier, A., Lachambre, P. et al. Evolution of non-invasive myocardial work in tako-tsubo cardiomyopathy. Int J Cardiovasc Imaging 38, 1795–1805 (2022). https://doi.org/10.1007/s10554-022-02641-9

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  • DOI: https://doi.org/10.1007/s10554-022-02641-9

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