Left ventricular function after takotsubo is not fully recovered in long-term follow-up: A speckle tracking echocardiography study

Background: Complete improvement of left ventricle (LV) systolic function is an essential feature of takotsubo cardiomyopathy (TTC). It is suggested that 2-dimensional speckle tracking echocardiography (2D STE) can evaluate LV dysfunction more accurately than conventional echocardiography. Thus, the purpose of this research was to assertain whether LV function recovery is complete after the acute phase of TTC using 2D STE commencing 6 to 9 months after discharge. Methods: Thirty patients (29 females, 67 +/- 11 years) with an apical ballooning TTC pattern 225.5 +/- 27.4 days after their index event were enrolled. The control group consisted of 20 (19 females, 64 +/- 9 years) age- and sex-matched volunteers without structural heart disease. Classic echocardiographic parameters, longitudinal strain and LV twist parameters were assessed and compared between the groups. Results: There were no differences in traditional LV systolic, diastolic parameters and in global peak longitudinal strain. In comparison to controls, patients with TTC had lower mean apical rotation (14.4 degrees +/- 6.5 degrees vs. 18.3 degrees +/- 6.7 degrees; p = 0.048), slower mean peak early diastolic apical rotation rate (-85.1-degrees/s +/- 40.9-degrees/s vs -119.4-degrees/s +/- 41.9-degrees/s; p = 0.006) and higher pre-stretch index in the apex (2.16, IQR 0.33-5.50 vs. 0.00, IQR 0.00-2.95, p = 0.008). Conclusions: The improvement of LV function in patients with TTC as assessed by 2D STE may not always be complete. Some residual abnormalities in LV apex function were observed in long-term recovery following TTC episodes.