Kim Sung-Ai, Jo Sang-Ho, Park Kyoung-Ha, Kim Hyun-Sook, Han Sang-Jin, Park Woo-Jung
Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
Division of Cardiology, Hallym Sacred Heart Hospital, Hallym University College of Medicine, Anyang, Republic of Korea.
J Cardiol. 2017 Jul;70(1):68-73. doi: 10.1016/j.jjcc.2016.09.006. Epub 2016 Nov 23.
Takotsubo cardiomyopathy (TC) is acute, but completely reversible in the absence of significant coronary artery disease. This study aims to assess the functional recovery of regional myocardial deformation in patients with TC using 2-dimensional (2D) speckle tracking echocardiography.
Thirty-three patients diagnosed with TC (mean age 63 years, 26 female) prospectively underwent serial 2D echocardiography on day 1 (initial presentation), day 4 [the middle, interquartile range (IQR), 2-5 days], and day 21 (recovery, IQR 13-32 days). Twenty-one (64%) patients showed classical type of TC with akinesis of mid-left ventricular (LV) and apical segments and 12 (36%) of patients presented with mid-LV variant with apical sparing. Myocardial deformations were serially assessed using 2D strain analysis. All echocardiographic values on day 21 were compared with the corresponding values from 30 controls of similar age and gender.
LV ejection fraction (EF) gradually improved at follow-up (32±8% on day 1 vs. 62±4% on day 21, p<0.001). Despite no difference in LVEF between the patients with complete recovery (LVEF >60% on day 21) and controls, the patients showed significantly lower global longitudinal strain than controls. On regional analysis of the mid-LV segments, both longitudinal and circumferential strains of patients with TC were similarly diminished on day 1. During recovery, longitudinal strain showed more delayed recovery than circumferential strain compared to the values of controls. In LV apex of controls, circumferential strain normally presented higher value than longitudinal strain. In LV apex of patients with classical TC, the reduced circumferential strain on day 1 rapidly increased with a wide variation to maintain augmented circumferential shortening.
Quantifying LV myocardial deformation in patients with TC is informative in the detection of persistent subtle LV dysfunction and improves our understanding of regional myocardial mechanics during recovery.
Takotsubo心肌病（TC）是急性的，但在无显著冠状动脉疾病的情况下可完全逆转。本研究旨在使用二维（2D）斑点追踪超声心动图评估TC患者局部心肌变形的功能恢复情况。
33例诊断为TC的患者（平均年龄63岁，26例女性）在第1天（初次就诊）、第4天[中间值，四分位间距（IQR），2 - 5天]和第21天（恢复，IQR 13 - 32天）前瞻性地接受了系列2D超声心动图检查。21例（64%）患者表现为典型的TC类型，左心室（LV）中部和心尖段运动减弱，12例（36%）患者表现为LV中部变异型，心尖未受累。使用2D应变分析对心肌变形进行系列评估。将第21天的所有超声心动图值与30例年龄和性别相似的对照组的相应值进行比较。
随访期间LV射血分数（EF）逐渐改善（第1天为32±8%，第21天为62±4%，p<0.001）。尽管完全恢复的患者（第21天LVEF>60%）与对照组之间的LVEF无差异，但患者的整体纵向应变显著低于对照组。在LV中部节段的区域分析中，TC患者的纵向和圆周应变在第1天同样降低。在恢复过程中，与对照组的值相比，纵向应变的恢复比圆周应变更延迟。在对照组的LV心尖，圆周应变通常呈现高于纵向应变的值。在典型TC患者的LV心尖，第1天降低的圆周应变迅速增加，变化范围广泛，以维持增强的圆周缩短。
量化TC患者的LV心肌变形有助于检测持续存在的细微LV功能障碍，并增进我们对恢复过程中局部心肌力学的理解。
