Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito, 1, Rome 00168, Italy.
Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
Eur Heart J Cardiovasc Imaging. 2023 May 31;24(6):699-707. doi: 10.1093/ehjci/jead045.
The aim of our study is to assess the ability of left atrial (LA) strain values to improve left ventricular and diastolic pressure (LVEDP) non-invasive estimation as compared with traditional echocardiographic indexes in the acute phase of Takotsubo syndrome (TTS) and to predict adverse in-hospital outcomes in this population.
Consecutive TTS patients were prospectively enrolled. Left ventricular and diastolic pressure was measured at the time of catheterization. Transthoracic echocardiography was performed within 48 h from hospital admission. In-hospital complications (acute heart failure, death from any cause, and life-threatening arrhythmias) were collected. A total of 62 patients were analysed (72.2 ± 10.1 years, female 80%) and in-hospital complications occurred in 25 (40.3%). Left ventricular and diastolic pressure mean value was 24.53 ± 7.92 mmHg. Left atrial reservoir and pump strain values presented higher correlation with LVEDP (r -0.859, P < 0.001 and r -0.848, P < 0.001, respectively) in comparison with E/e ' ratio, left atrial volume index (LAVi), and tricuspid regurgitation (TR) peak velocity. In addition, at receiver-operating characteristic curve analysis, LA reservoir and pump strain resulted to be better predictors of LVEDP above the mean of our population [0.909 (95% CI 0.818-0.999, P < 0.001) and 0.889 (95% CI 0.789-0.988, P < 0.001)], respectively] as compared with E/e' ratio, LAVi, and TR peak velocity.Finally, LA reservoir strain resulted to be an independent predictor of worse in-hospital outcomes, together with LVEDP and left ventricular ejection fraction (all P < 0.001).
In our study, lower LA reservoir and pump strain values were better predictors of LVEDP as compared with traditional echocardiographic indexes in the acute phase of TTS syndrome. Moreover, LA reservoir strain was an independent predictor of adverse in-hospital outcomes.
本研究旨在评估左心房（LA）应变值在急性 Takotsubo 综合征（TTS）患者中与传统超声心动图指标相比，在无创性估计左心室和舒张末期压力（LVEDP）方面的能力，并预测该人群的不良住院结局。
连续入选 TTS 患者。在导管插入术时测量左心室和舒张末期压力。入院后 48 小时内行经胸超声心动图检查。收集住院期间并发症（急性心力衰竭、任何原因死亡和危及生命的心律失常）。共分析 62 例患者（72.2±10.1 岁，女性 80%），25 例（40.3%）发生住院期间并发症。左心室和舒张末期压力平均值为 24.53±7.92mmHg。与 E/e' 比值、左心房容积指数（LAVi）和三尖瓣反流（TR）峰值速度相比，左心房储备和泵应变值与 LVEDP 的相关性更高（r=-0.859，P<0.001 和 r=-0.848，P<0.001）。此外，在接受者操作特征曲线分析中，LA 储备和泵应变值在预测人群平均以上的 LVEDP 方面表现出更好的预测能力[0.909（95%CI 0.818-0.999，P<0.001）和 0.889（95%CI 0.789-0.988，P<0.001）]，与 E/e' 比值、LAVi 和 TR 峰值速度相比。最后，LA 储备应变值与 LVEDP 和左心室射血分数一起成为住院不良结局的独立预测因子（均 P<0.001）。
在本研究中，与 TTS 综合征急性期的传统超声心动图指标相比，较低的 LA 储备和泵应变值是 LVEDP 的更好预测指标。此外，LA 储备应变值是不良住院结局的独立预测因子。
