title: Global and regional myocardial function quantification in Takotsubo cardiomyopathy in comparison to acute anterior myocardial infarction using two-dimensional (2D) strain echocardiography.
abstract: OBJECTIVE
  This study sought to compare global and regional myocardial function in Takotsubo cardiomyopathy (TC) to that in acute anterior myocardial infarction (AMI) using 2D strain imaging.
  
  
  METHODS
  Twelve consecutive patients with TC (ten women, two men) and 12 patients with AMI (four women, eight men) underwent 2D echocardiography at initial presentation. 2D strain images were analyzed to measure longitudinal and radial strain. Global strain was calculated as the average longitudinal strain of the segments of two-, three-, and four-chamber views. Biplane ejection fraction was assessed using Simpson's biplane method.
  
  
  RESULTS
  Significant differences in radial strain (TC vs. AMI) were found in lateral (13.5 ± 10.1% vs. 25.1 ± 11.2%, P = 0.035), posterior (15.2 ± 14.5% vs. 51.4 ± 14.2%, P < 0.001), and inferior (17.9 ± 15.5% vs. 49.4 ± 16.9%, P = 0.002) segments. Longitudinal strain was significantly lower in TC in basal-inferior (-15.8 ± 9.2% vs. -22.7 ± 3.8%, P = 0.037), midinferior (-8.3 ± 9.2% vs. -16.8 ± 3.0%, P = 0.004), basal-posterior (-12.2 ± 9.4% vs. -21.6 ± 4.4%, P = 0.016), midposterior (-4.4 ± 8.0% vs. -15.4 ± 3.5%, P = 0.002), apical-posterior (2.3 ± 6.7% vs. -6.4 ± 10.1%, P = 0.023), and midlateral (-3.4 ± 6.9% vs. -9.5 ± 5.8%, P = 0.028) segments. Global strain and ejection fraction were significantly higher in patients with AMI (-3.5 ± 8.2% vs. -10.3 ± 8.4%, P < 0.001 and 37 ± 11% vs. 46 ± 11%, P = 0.045).
  
  
  CONCLUSIONS
  In TC, strain was reduced around the entire mid left-ventricular circumference, whereas in AMI it was predominantly reduced in the anterior and anteroseptal wall. These observed differences confirm the notion that TC affects myocardium beyond the territory of a single coronary artery. They may allow noninvasive distinction between both entities.
authors.affiliation: First Medical Department, University Medical Centre Mannheim, University of Heidelberg, Germany. felixheggemann@gmx.de
authors.forename: Felix
authors.initials: F
authors.lastname: Heggemann
authors.forename: Karsten
authors.initials: K
authors.lastname: Hamm
authors.forename: Thorsten
authors.initials: T
authors.lastname: Kaelsch
authors.forename: Tim
authors.initials: T
authors.lastname: Sueselbeck
authors.forename: Theano
authors.initials: T
authors.lastname: Papavassiliu
authors.forename: Martin
authors.initials: M
authors.lastname: Borggrefe
authors.forename: Dariusch
authors.initials: D
authors.lastname: Haghi
mesh_terms: D000368:Aged; D015897:Comorbidity; D004452:Echocardiography / Q000379:methods*; D005260:Female; D006801:Humans; D007090:Image Interpretation, Computer-Assisted; D008297:Male; D008875:Middle Aged; D009203:Myocardial Infarction / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D018709:Statistics, Nonparametric; D013318:Stroke Volume; D054549:Takotsubo Cardiomyopathy / Q000000981:diagnostic imaging* / Q000503:physiopathology*