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Left and right ventricular systolic long-axis function and diastolic function in patients with takotsubo cardiomyopathy
Örebro University, School of Health and Medical Sciences. Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
Clinical Physiology, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0002-4262-6373
Cardiology, Örebro University Hospital, Örebro, Sweden.
Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
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2011 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 31, no 3, p. 203-208Article in journal (Refereed) Published
Abstract [en]

Aims: Takotsubo cardiomyopathy is characterized by apical wall motion abnormalities without coronary stenosis. Limited information is available on the genesis of the underlying reversible contractile disorder. Our objective in this prospective study was to investigate biventricular changes in systolic long-axis function and diastolic parameters in the acute phase and after recovery.

Methods and results: Thirteen consecutive patients were examined by echocardiography and coronary angiography at admission and again by echocardiography after 3 months. Amplitudes, systolic and diastolic velocities of the mitral and tricuspid annuli and conventional diastolic parameters were measured. Systolic long-axis shortening of the left ventricle (LV) and right ventricle (RV) improved from 9·6 ± 2·2 mm to 11·2 ± 1·9 mm (P = 0·02) and from 21·3 ± 3·6 mm to 24·1 ± 2·8 mm (P = 0·02), respectively. LV systolic, early and late diastolic velocities measured by pulsed-wave tissue Doppler also improved, while additional conventional diastolic parameters of the LV and RV diastolic function were unchanged.Conclusions: Takotsubo cardiomyopathy temporarily affects systolic LV and RV function, while most diastolic parameters remain unchanged

Place, publisher, year, edition, pages
Oxford: Wiley , 2011. Vol. 31, no 3, p. 203-208
Keyword [en]
annulus motion, atrioventricular displacement, doppler, echocardiography, heart
National Category
Cardiac and Cardiovascular Systems
Research subject
Internal Medicine; Cardiology
Identifiers
URN: urn:nbn:se:oru:diva-14631DOI: 10.1111/j.1475-097X.2010.01001.xISI: 000289258100007PubMedID: 21138516Scopus ID: 2-s2.0-79953745331OAI: oai:DiVA.org:oru-14631DiVA, id: diva2:397731
Available from: 2011-02-15 Created: 2011-02-15 Last updated: 2018-02-07Bibliographically approved
In thesis
1. Echocardiographic measurements of the heart: with focus on the right ventricle
Open this publication in new window or tab >>Echocardiographic measurements of the heart: with focus on the right ventricle
2011 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Echocardiography is a well established technique when evaluating the size and function of the heart. One of the most common ways to measure the size of the right ventricle (RV) is to measure the RV outflow tract 1(RVOT1). Several ways to measure RVOT1 are described in the literature.These ways were compared with echocardiography on 27 healthy subjects.The result showed significant differences in RVOT1, depending on the way it was measured, concluding that the same site, method and body positionshould be used when comparing RVOT1 in the same subject over time.One parameter to evaluate the RV diastolic function (RVDF) is to measure the RV isovolumetric relaxation time (RV-IVRT), a sensitive marker ofRV dysfunction. There are different ways to measure this. In this thesis two ways of measuring RV-IVRT and their time intervals were compared in 20 patients examined with echocardiography. There was a significant difference between the two methods indicating that they are not measuring the same interval.Another way to assess the RVDF is to measure the maximal early diastolicvelocity (MDV) in the long-axis direction. MDV can be measured bydifferent methods, hence 29 patients were examined and MDV was measured according to two methods. There was a good correlation but a poor agreement between the two methods meaning that reference values cannot be used interchangeably.Takotsubo cardiomyopathy is characterized by apical wall motion abnormalities without coronary stenosis. The pathology of this condition remains unclear. To evaluate biventricular changes in systolic long-axisfunction and diastolic parameters in the acute phase and after recovery, 13 patients were included and examined with echocardiography at admission and after recovery. The results showed significant biventricular improvementof systolic long-axis function while most diastolic parameters remainedunchanged.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2011. p. 63
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 52
Keyword
Echocardiography, heart, right ventricle, right ventricular outflow tract 1, isovolumetric relaxation time, maximal early diastolic relaxation velocity, takotsubo cardiomyopathy, long-axis function
National Category
Medical and Health Sciences Physiology
Research subject
Biomedicine
Identifiers
urn:nbn:se:oru:diva-14528 (URN)978-91-7668-783-3 (ISBN)
Public defence
2011-03-11, Wilandersalen, Örebro universitetssjukhus, Örebro, 13:00 (Swedish)
Opponent
Supervisors
Available from: 2011-02-09 Created: 2011-02-09 Last updated: 2018-01-12Bibliographically approved
2. Echocardiographic measurements at Takotsubo cardiomyopathy: transient left ventricular dysfunction
Open this publication in new window or tab >>Echocardiographic measurements at Takotsubo cardiomyopathy: transient left ventricular dysfunction
2014 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Takotsubo cardiomyopathy (TTC) is a disease characterized by transient left ventricular (LV) dysfunction and typical wall motion abnormalities in apical parts, without obvious signs of coronary influence. Due to its elusive natural cause and the lack of clarified pathology, further studies are needed. Thirteen patients presented with an episode of TTC, and referred to Örebro University Hospital (USÖ), were prospectively included and investigated by comparisons made at onset (acute phase) against at follow-up three months later (recovery phase). Including echocardiographic measurements, focused on biventricular systolic long-axis function and conventional diastolic function (DF) variables. Systolic improvement was shown, while most DF data were unchanged, suggesting that TTC is mainly a systolic disease affecting both ventricles.

Diagnosis should include multidisciplinary engagement, as TTC associates both with emotional stress and pathological markers of physiological stress. In this thesis, such approach was offered to the aforementioned patients; to see if a common denominator could be found, thus, contributing to better handling. Emotional state was assessed, along with an array of cardiac investigations in addition to echocardiography. Acutely, imbalance in the autonomic cardiac control was shown, as well as a trend toward posttraumatic stress, but specific findings allowing conclusions on differential diagnosis could not be demonstrated.

By adding another 15 TTC patients (i.e. 28 in total), through collaboration with observers from USA, a retrospective echocardiographic analysis could be done to further study DF; concluding that TTC associates with impairment of conventional DF variables which tends to parallel the systolic recovery, in contrary to the initial result but in line with other causesof LV dysfunction.

Magnetic resonance imaging (MRI) is another method of choice at TTC. The USÖ patients had cardiac MRI, thus, a retrospective analysis was done to investigate the effect on LV geometry, both echocardiographic and by MRI; suggesting that TTC is consistently associated with increased LV mass, due to a local impact that seems to follow the change in LVconcentric wall motion.

Place, publisher, year, edition, pages
Örebro: Örebro university, 2014. p. 106
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 111
Keyword
Echocardiography, takotsubo, annulus motion, cardiac autonomic function, broken heart, diastolic, ventricular mass, concentric wall motion
National Category
Other Basic Medicine
Research subject
Medicine; Biomedicine
Identifiers
urn:nbn:se:oru:diva-35798 (URN)978-91-7529-049-2 (ISBN)
Public defence
2014-11-28, Universitetssjukhuset, hörsal C3, Södra Grev Rosengatan, Örebro, 10:00 (English)
Opponent
Supervisors
Available from: 2014-07-24 Created: 2014-07-24 Last updated: 2018-02-07Bibliographically approved

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Loiske, KarinWaldenborg, MicaelFröbert, OleEmilsson, Kent

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