Supervisors info:
Ξάνθος Θεόδωρος, Καθηγητής, Τμήμα Μαιευτικής, ΠΑΔΑ
Ιακωβίδου Νικολέττα, Καθηγήτρια, Ιατρική Σχολή, ΕΚΠΑ
Εκμεκτζόγλου Κωνσταντίνος, Επίκουρος Καθηγητής, Ευρωπαϊκό Πανεπιστήμιο Κύπρου
Summary:
Introduction: Takotsubo cardiomyopathy is one of the main differential diagnoses in patients with acute coronary syndrome and coronary vessels without hemodynamically significant stenoses. Its classic form, characterized by extensive apical immobility, is easily recognizable echocardiographically. In contrast, the rarer medial or basal forms and the focal form are often underdiagnosed.
Purpose: The purpose of the present study was to study the role of global (GLS) and regional longitudinal strain with speckle tracking for the assessment of patients with Takotsubo cardiomyopathy.
Of the total of 30 people who participated, 83.3% were women and the average age of the patients at the time of their admission to the study is 66.4 years (Standard Deviation (SD) 14.4 years). The most important results obtained from the study are as follows, 42.9% and 60.7% manifested an emotional and physical trigger, respectively. 78.6% had chest pain, while the remaining 21.4% had shortness of breath. The majority had ST elevation with a rate of 34.6%, 19.2% showed ST elevation while 46.2% did not show ST segment changes. In our study, 6.7% developed cardiogenic shock and hemodynamic instability, 17.2% atrial fibrillation, while no patient died. In addition, the study showed a statistically significant negative association of myocardial necrosis enzyme with change in ejection fraction, because the higher troponin values patients had, the lower the improvement in ejection fraction in the 2nd study.Patients who experienced cardiogenic shock had lower values of all ultrasound indices during the 1st visit, compared to those who did not exhibit this complication, at the same time they had a smaller median change in the values of the indices between the two visits. That is, they showed less improvement in the newer ultrasound markers, a fact that was also confirmed with the ejection fraction.Regarding the type of apex cardiomyopathy, the change in indices is by median value greater.
Finally, it is worth mentioning that patients with type of cardiomyopathy mid, have a statistically significant difference in the change in the ejection fraction and show a greater change. On the other hand, for patients with a type of focal cardiomyopathy, there is a statistically significant difference in the change in myocardial work, and more specifically, the change in the indicators is, by a median value, smaller in those with the specific type of cardiomyopathy. Regarding the most popular Takotsubo balloon-like morphology, it appeared that the change in the indices between the 2 studies was by a median value greater.
Conclusions: In conclusion, the newest ultrasound techniques in Takotsubo cardiomyopathy initially help us to confirm the motility disorders, moreover, it allows us to highlight the type of cardiomyopathy because apart from the balloon-like morphology of TTS, the other phenotypes are underdiagnosed and difficult to recognize. In addition, newer techniques help us to predict the patient's course. Finally, the regional longitudinal deformation adequately reflects the visual assessment of the distribution of motility disorders, further strengthening the diagnosis.
Keywords:
Takotsubo syndrome, Ultrasound, Echocardiography, Speckle tracking, Broken heart
