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Echocardiographic measurements at Takotsubo cardiomyopathy: transient left ventricular dysfunction
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden.
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. , 106 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 111
Keyword [en]
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: urn:nbn:se:oru:diva-35798ISBN: 978-91-7529-049-2 (print)OAI: oai:DiVA.org:oru-35798DiVA: diva2:735226
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: 2016-12-12Bibliographically approved
List of papers
1. Left and right ventricular systolic long-axis function and diastolic function in patients with takotsubo cardiomyopathy
Open this publication in new window or tab >>Left and right ventricular systolic long-axis function and diastolic function in patients with takotsubo cardiomyopathy
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2011 (English)In: Clinical Physiology and Functional Imaging, ISSN 1475-0961, E-ISSN 1475-097X, Vol. 31, no 3, 203-208 p.Article 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
Keyword
annulus motion, atrioventricular displacement, doppler, echocardiography, heart
National Category
Cardiac and Cardiovascular Systems
Research subject
Internal Medicine; Cardiology
Identifiers
urn:nbn:se:oru:diva-14631 (URN)10.1111/j.1475-097X.2010.01001.x (DOI)000289258100007 ()21138516 (PubMedID)2-s2.0-79953745331 (Scopus ID)
Available from: 2011-02-15 Created: 2011-02-15 Last updated: 2017-03-27Bibliographically approved
2. Multidisciplinary assessment of takotsubo cardiomyopathy: a prospective case study
Open this publication in new window or tab >>Multidisciplinary assessment of takotsubo cardiomyopathy: a prospective case study
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2011 (English)In: BMC Cardiovascular Disorders, ISSN 1471-2261, E-ISSN 1471-2261, Vol. 11, 14- p.Article in journal (Refereed) Published
Abstract [en]

Background: The cause of tako tsubo cardiomyopathy remains unclear. We used a multidisciplinary approach to investigate if a common pathophysiological denominator could be outlined.

Methods: Within 3 days following symptom presentation and again after 3 months we investigated all patients coming to our institution and diagnosed with tako-tsubo cardiomyopathy. Patients underwent extensive biochemical screening. Left ventricular function was evaluated by echocardiography and contrast-enhanced cardiac magnetic resonance imaging. Cardiac autonomic function was studied by heart rate variability and signal-averaged electrocardiogram and posttraumatic stress and depression were investigated by questionnaires (the Posttraumatic Stress Syndrome 10-Questions Inventory, PTSS-10 and the Montgomery-Asberg depression rating scale, self rated version, MADRS-S).

Results: During 2 years, 13 consecutive patients were included. Markers of myocardial damage and heart failure were slightly to moderately elevated and ejection fraction (echocardiography and MRi) was moderately reduced at hospitalization and improved to normal values in all patients. Signal averaged ECG demonstrated a statistically significant shorter duration of the filtered QRS complex in the acute phase as compared to follow-up. In heart rate variability analysis, SDNN and SDANN were shorter acutely compared to follow-up. Two patients fulfilled criteria for posttraumatic stress syndrome while 7 patients were in the borderline zone. There was a statistically significant inverse correlation between PTSS-10 score and QRS duration in the signal-averaged ECG (r = -0.66, P = 0.01).

Conclusions: Patients with tako tsubo cardiomyopathy have altered cardiac autonomic function and a high incidence rate of borderline or definite posttraumatic stress syndrome acutely. This is in line with findings in patients with myocardial infarction and does not allow conclusions on cause and effect.

National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:oru:diva-38886 (URN)10.1186/1471-2261-11-14 (DOI)000290201700001 ()21477336 (PubMedID)2-s2.0-79953741085 (Scopus ID)
Note

This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Available from: 2014-11-21 Created: 2014-11-21 Last updated: 2017-01-09Bibliographically approved
3. Diastolic function improves after resolution of takotsubo cardiomyopathy
Open this publication in new window or tab >>Diastolic function improves after resolution of takotsubo cardiomyopathy
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2012 (English)In: European Heart Journal, ISSN 0195-668X, E-ISSN 1522-9645, Vol. 33, no suppl 1, 801-801 p.Article in journal, Meeting abstract (Other academic) Published
Place, publisher, year, edition, pages
Oxford University Press, 2012
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:oru:diva-38887 (URN)10.1093/eurheartj/ehs283 (DOI)000308012406026 ()25208087 (PubMedID)
Conference
Congress of the European-Society-of-Cardiology (ESC), AUG 25-29, 2012, Munchen, GERMANY
Available from: 2014-11-21 Created: 2014-11-21 Last updated: 2017-03-26Bibliographically approved
4. Effect on left ventricular mass and geometry in patients with takotsubo cardiomyopathy
Open this publication in new window or tab >>Effect on left ventricular mass and geometry in patients with takotsubo cardiomyopathy
(English)Manuscript (preprint) (Other academic)
Abstract [en]

Aims: Takotsubo cardiomyopathy (TTC) is a condition of reversible left ventricular (LV) dysfunction. The effects, from acute to recovery phase, on LV mass (LVM) and the LV geometry are not thoroughly enough studied at TTC, which were the main aims of the present study. Retrospectively, we analyzed our cohort of TTC-patients, both with transthoracic echocardiography (TTE) and magnetic resonance imaging (MRI), to further investigate these changes, including intertechnique comparison.

Methods: We studied 13 female TTC-patients, undergoing TTE and MRI acutely, and three months later at follow-up. LVM was measured with MRI- and five different TTE-methods. Segmental wall thickness (SWT) was assessed, and used for LV hypertrophy (LVH) geometry categorization. Radial strain was measured at TTE. Data analysis included Wilcoxon signed-test (between phases), Mann Whitney U- and McNemar’s tests (between and within groups). Spearman’s coefficient was used for intertechnique coherence (with BlandAltman plots) and for correlations of simultaneous TTE changes.

Results: LVM decreased significantly between phases (p<0.05), by MRI and with two TTE-methods. Two of three SWT-sites became significantly thinner, with adequate correlation (rs≥0.69) between techniques, while LVH categories remained unchanged. Relatively better consistency, compared with MRI, was shown for one of the TTE-methods used to estimate LVM (truncated ellipsoid (TE)). Radial strain improved significantly, with partial correlation towards the TE-method.

Conclusions: TTC associates with acute increase in LVM, which seems to be a local effect, tending to occur in parallel with changes in concentric wall motion. MRI and TTE shows adequate consistency, primarily for the TE-method regarding LVM.

Keyword
Stress-induced cardiomyopathy, Apical ballooning syndrome, Left ventricular morphology, Two-dimensional echocardiography, Concentric wall motion
National Category
Cardiac and Cardiovascular Systems
Research subject
Cardiology
Identifiers
urn:nbn:se:oru:diva-38888 (URN)
Available from: 2014-11-21 Created: 2014-11-21 Last updated: 2014-12-09Bibliographically approved

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