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Effect on left ventricular mass and geometry in patients with takotsubo cardiomyopathy
Örebro University, School of Health and Medical Sciences, Örebro University, Sweden. Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.ORCID iD: 0000-0002-4262-6373
Department of Radiology, Örebro University Hospital, Örebro, Sweden.
Department of Radiology, Örebro University Hospital, Örebro, Sweden.
Department of Clinical Physiology, Örebro University Hospital, Örebro, Sweden.
(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.

Keywords [en]
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: urn:nbn:se:oru:diva-38888OAI: oai:DiVA.org:oru-38888DiVA, id: diva2:765053
Available from: 2014-11-21 Created: 2014-11-21 Last updated: 2018-02-07Bibliographically approved
In thesis
1. 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
Keywords
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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Waldenborg, MicaelLidén, MatsEmilsson, Kent

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