MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA.
MedStar Heart and Vascular Institute, MedStar Washington Hospital Center, Washington, DC, USA.
Cardiovasc Revasc Med. 2021 Jun;27:45-51. doi: 10.1016/j.carrev.2020.07.021. Epub 2020 Jul 25.
Takotsubo cardiomyopathy (TTC) is characterized by transient left ventricular (LV) dysfunction, electrocardiographic changes that can mimic acute myocardial infarction (MI), and release of myocardial enzymes in the absence of obstructive coronary artery disease (CAD). Conventionally, gross visual assessment of LV angiogram has been used to classify TTC. We aim to compare quantitative assessment of different regions of LV on angiogram and segmental strain on transthoracic echo to determine a better way to classify TTC rather than conventional qualitative visual assessment.
We conducted a retrospective observational study of 20 patients diagnosed with TTC who had LV angiogram and transthoracic echocardiograms performed on presentation that were suitable for analysis. Twenty LV angiograms were analyzed using Rubo DICOM viewer software. Areas of different LV regions were measured in diastole and systole, and percentage changes in area of these regions were calculated. Percentage changes in area of less than 10% was considered "akinetic." On the other hand, using echocardiograms of these patients, LV regional longitudinal strain (LS) was derived from speckle-tracking analysis. These findings were compared to determine concordance between both modalities.
On quantitative analysis of 20 LV angiograms, the area of all the three LV regional (apex, mid ventricle, and base) shortening (>10%) was observed in 16 patients (80%) during systole as compared to diastole. However, only 4 out of 20 patients (20%) were noted to have apical region area change of <10% between diastole and systole. Analysis of LV regional LS patterns of 20 patients showed that 14 patients had abnormal values (> -18%) in all three LV regions: apex, mid ventricle, and base. The apical region was the most severely affected region (mean LS -13.9%), followed by the basal region (mean -14.7%) and the mid ventricular region (mean -15.1%). Comparing the results of both modalities showed that there was 35% (n = 7) concordance in the results noted for base and apical regions of the LV, whereas only 20% (n = 4) concordance was noted in mid ventricular region.
Contractility (shortening) on LV angiogram is present in a majority of patients in the three LV regions, but contractility assessed by LS is impaired in most of them. The concordance in both quantitative assessment modalities was low. LV angiogram may not be an accurate imaging modality to assess contractility patterns in Takotsubo patients, and echocardiographic LS analysis should be taken as the preferred imaging modality.
Takotsubo 心肌病（TTC）的特征是短暂的左心室（LV）功能障碍、可模拟急性心肌梗死（MI）的心电图变化以及心肌酶的释放，而不存在阻塞性冠状动脉疾病（CAD）。传统上，LV 血管造影的大体视觉评估用于对 TTC 进行分类。我们旨在比较血管造影不同 LV 区域的定量评估和经胸超声心动图的节段应变，以确定一种优于传统定性视觉评估的更好的分类方法。
我们对 20 名经诊断患有 TTC 的患者进行了回顾性观察性研究，这些患者在就诊时均进行了 LV 血管造影和经胸超声心动图检查，这些检查适合进行分析。使用 Rubo DICOM 查看器软件对 20 个 LV 血管造影进行了分析。测量舒张期和收缩期不同 LV 区域的面积，并计算这些区域面积的百分比变化。面积变化小于 10%被认为是“无运动”。另一方面，使用这些患者的超声心动图，从斑点追踪分析中得出 LV 节段纵向应变（LS）。将这些发现进行比较，以确定两种方式之间的一致性。
在对 20 个 LV 血管造影的定量分析中，与舒张期相比，在收缩期观察到 16 名患者（80%）的所有三个 LV 区域（心尖、中部和基底）的面积均缩短（>10%）。然而，只有 20 名患者中的 4 名（20%）在心尖区域的面积变化在舒张期和收缩期之间小于 10%。对 20 名患者的 LV 节段 LS 模式进行分析后发现，14 名患者的三个 LV 区域（心尖、中部和基底）的异常值（>-18%）。心尖区域受影响最严重（平均 LS-13.9%），其次是基底区域（平均-14.7%）和中部心室区域（平均-15.1%）。比较两种方式的结果表明，LV 基底和心尖区域的结果有 35%（n=7）的一致性，而中部心室区域的结果只有 20%（n=4）的一致性。
LV 血管造影显示大多数患者的 LV 三个区域的收缩力（缩短）存在，但大多数患者的 LS 评估收缩力受损。两种定量评估方式的一致性较低。LV 血管造影可能不是评估 Takotsubo 患者收缩力模式的准确成像方式，应将超声心动图 LS 分析作为首选成像方式。
