Relation of delayed recovery of myocardial function after takotsubo cardiomyopathy to subsequent quality of life.
Takotsubo cardiomyopathy (TTC) has generally been regarded as a relatively transient disorder, characterized by reversible regional left ventricular systolic dysfunction. However, most patients with TTC experience prolonged lassitude or dyspnea after acute attacks. Although this might reflect continued emotional stress, myocardial inflammation and accentuated brain-type natriuretic peptide (BNP) release persist for at least 3 months. We therefore tested the hypotheses that this continued inflammation is associated with (1) persistent contractile dysfunction and (2) consequent impairment of quality of life. Echocardiographic parameters (global longitudinal strain [GLS], longitudinal strain rate [LSR], and peak apical twist [AT]) were compared acutely and after 3 months in 36 female patients with TTC and 19 age-matched female controls. Furthermore, correlations were sought between putative functional anomalies, inflammatory markers (T2 score on cardiovascular magnetic resonance, plasma NT-proBNP, and high-sensitivity C-reactive protein levels), and the physical composite component of SF36 score (SF36-PCS). In TTC cases, left ventricular ejection fraction returned to normal within 3 months. GLS, LSR, and AT improved significantly over 3-month recovery, but GLS remained reduced compared to controls even at follow-up (-17.9 ± 3.1% vs -20.0 ± 1.8%, p = 0.003). Impaired GLS at 3 months was associated with both persistent NT-proBNP elevation (p = 0.03) and reduced SF36-PCS at ≥3 months (p = 0.04). In conclusion, despite normalization of left ventricular ejection fraction, GLS remains impaired for at least 3 months, possibly as a result of residual myocardial inflammation. Furthermore, perception of impaired physical exercise capacity ≥3 months after TTC may be explained by persistent myocardial dysfunction.
Department of Cardiology, the Queen Elizabeth Hospital, Woodville South, South Australia, Australia; Basil Hetzel Institute, The University of Adelaide, Woodville South, South Australia, Australia.
Christopher J
CJ
Neil
Department of Cardiology, the Queen Elizabeth Hospital, Woodville South, South Australia, Australia; Basil Hetzel Institute, The University of Adelaide, Woodville South, South Australia, Australia.
Thanh H
TH
Nguyen
Department of Cardiology, the Queen Elizabeth Hospital, Woodville South, South Australia, Australia; Basil Hetzel Institute, The University of Adelaide, Woodville South, South Australia, Australia.
Kuljit
K
Singh
Department of Cardiology, the Queen Elizabeth Hospital, Woodville South, South Australia, Australia; Basil Hetzel Institute, The University of Adelaide, Woodville South, South Australia, Australia.
Betty
B
Raman
Department of Cardiology, the Queen Elizabeth Hospital, Woodville South, South Australia, Australia.
Jeanette
J
Stansborough
School of Medicine & Dentistry, The University of Aberdeen, Aberdeen, United Kingdom.
Dana
D
Dawson
School of Medicine & Dentistry, The University of Aberdeen, Aberdeen, United Kingdom.
Michael P
MP
Frenneaux
Department of Cardiology, the Queen Elizabeth Hospital, Woodville South, South Australia, Australia; Basil Hetzel Institute, The University of Adelaide, Woodville South, South Australia, Australia. Electronic address: john.horowitz@adelaide.edu.au.
John D
JD
Horowitz
D000368:Aged; D015415:Biomarkers / Q000097:blood; D002097:C-Reactive Protein / Q000378:metabolism; D018618:Echocardiography, Doppler, Color / Q000379:methods; D004562:Electrocardiography; D005260:Female; D005500:Follow-Up Studies; D006352:Heart Ventricles / Q000000981:diagnostic imaging / Q000473:pathology / Q000503:physiopathology*; D006801:Humans; D019028:Magnetic Resonance Imaging, Cine / Q000379:methods; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000097:blood; D010446:Peptide Fragments / Q000097:blood; D011379:Prognosis; D011446:Prospective Studies; D011788:Quality of Life; D020127:Recovery of Function; D013318:Stroke Volume; D011795:Surveys and Questionnaires; D054549:Takotsubo Cardiomyopathy / Q000175:diagnosis / Q000503:physiopathology* / Q000523:psychology; D013997:Time Factors; D016277:Ventricular Function, Left / Q000502:physiology*
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain; D002097:C-Reactive Protein