title: Assessment of left ventricular twist mechanics in Tako-tsubo cardiomyopathy by two-dimensional speckle-tracking echocardiography.
abstract: OBJECTIVE
  To assess left ventricular (LV) twist mechanics in patients with Tako-tsubo cardiomyopathy (TTC).
  
  
  RESULTS
  Two-dimensional strain and LV twist by speckle-tracking echocardiography was performed in 17 consecutive patients with typical TTC according to the Mayo clinic criteria [78 ± 8 years, 88% women, and mean left ventricular ejection fraction (LVEF) 45 ± 10%], at the acute phase (within 24 h after admission) and after recovery (1 month later). Seventeen control (C) patients matched for age and sex (mean LVEF 70 ± 7%), and 17 patients with acute anterior myocardial infarction (MI) treated by successful primary angioplasty 24 h before, matched for LVEF, age, and sex, were compared with TTC patients. LV twist was assessed using the parasternal basal and apical short-axis planes, and defined as the net difference in degrees of apical (Ar) and basal rotation (Br). Peak systolic and early diastolic, apical (As and Ad) and basal (Bs and Bd) rotation rate, and LV twisting rate (TR) and untwisting rate (UR) (in °/s) were derived from rotational and twist curves. The time sequences were normalized to the percentage of systolic duration. At the acute phase, Ar, As, Ad, Bs, LV twist (10 ± 9° vs. 23 ± 6°), LV TR, and LV UR were significantly impaired in patients with TTC when compared with controls (all, P < 0.05). Patients with MI displayed intermediate values (P = NS vs. TTC, and P < 0.05 vs. C). However, in the subgroup of patients with electrocardiogram ST-segment elevation at presentation (n = 12 TTC and 17 MI), several LV twist mechanics parameters were significantly reduced in TTC patients when compared with MI patients, LV twist, and LV TR being the most significant factors (all, P≤ 0.01). Abnormal reversed Ar (clockwise when seen from the apex) was seen in three patients (18%) with TTC vs. none in the other groups. A significant correlation between LV twist and LVEF, LV volumes, wall motion score index, and plasma NT-pro BNP was observed in the TTC group (all, P < 0.05). At follow-up, LV twist mechanics improved significantly in TTC patients (all, P < 0.05 vs. acute phase), who had final values similar to C (all, P = NS), whereas the magnitude of improvement was lower in MI patients (P ≤ 0.05 vs. TTC).
  
  
  CONCLUSIONS
  LV twist mechanics is significantly impaired in patients with TTC mainly due to a severe reduction in apical function and is entirely reversible. Furthermore, in the subgroup of patients with ST-segment elevation, the early post-admission evaluation of LV twist mechanics is more severely impaired in TTC when compared with MI.
authors.affiliation: Department of Cardiology and Intensive Care Unit, Centre Hospitalier de Compiegne, 8 Rue Henri Adnot, 60200 Compiegne, France. patrickmeimoun.md@gmail.com
authors.forename: Patrick
authors.initials: P
authors.lastname: Meimoun
authors.forename: Pricila
authors.initials: P
authors.lastname: Passos
authors.forename: Tahar
authors.initials: T
authors.lastname: Benali
authors.forename: Jacques
authors.initials: J
authors.lastname: Boulanger
authors.forename: Frederic
authors.initials: F
authors.lastname: Elmkies
authors.forename: Hamdane
authors.initials: H
authors.lastname: Zemir
authors.forename: Jerome
authors.initials: J
authors.lastname: Clerc
authors.forename: Anne
authors.initials: A
authors.lastname: Luycx-Bore
mesh_terms: D000368:Aged; D000465:Algorithms; D000704:Analysis of Variance; D015150:Echocardiography, Doppler / Q000379:methods*; D005260:Female; D006352:Heart Ventricles / Q000000981:diagnostic imaging* / Q000473:pathology; D006801:Humans; D008297:Male; D011446:Prospective Studies; D013223:Statistics as Topic; D054549:Takotsubo Cardiomyopathy / Q000000981:diagnostic imaging* / Q000473:pathology; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000473:pathology