title: Comparison of Left Ventricular Contractile Abnormalities in Stress-Induced Cardiomyopathy versus Obstructive Coronary Artery Disease Using Two-Dimensional Strain Imaging.
abstract: BACKGROUND
  Data on left ventricular (LV) strain profiles in patients with takotsubo cardiomyopathy (TC) in comparison with obstructive coronary artery disease (CAD) are limited. We sought to investigate regional and global LV longitudinal strain in a cohort of patients with known TC using two-dimensional strain imaging (2DS) in comparison with patients with acute cardiomyopathy (ACM) due to severe obstructive left anterior descending arterial disease or triple-vessel disease and healthy controls.
  
  
  METHODS
  Transthoracic echocardiography was performed in 34 patients with established TC, 24 patients with ACM, and 30 healthy subjects. We measured the segmental longitudinal strain in apical views by the use of EchoInsight Epsilon software. Left ventricular global longitudinal strain (GLS) was calculated by averaging segmental wall strains.
  
  
  RESULTS
  The TC and ACM groups were comparable for age and demographic characteristics. Systolic and diastolic function were significantly impaired in both groups compared to controls. LV global and segmental systolic strain was also significantly attenuated in patients with TC and ACM compared to controls (P < 0.001). Moreover, LV basal segmental longitudinal strain was higher in the patients with TC compared to ACM (P = 0.02). Global and apical segmental strain appear to be higher in patients with mid-ventricular variant compared to those with apical variant of TC with apical strain cutoff value of -7.85%, offering the best discriminatory value for differentiating these two patterns (P = 0.001).
  
  
  CONCLUSIONS
  The results of this hypothesis-generating study indicate that longitudinal LV strain parameters are similarly impaired in patients with TC and ACM due to severe obstructive left anterior descending arterial disease or triple-vessel disease. Assessment of two-dimensional LV strain parameters could help differentiate between different TC patterns.
authors.affiliation: Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Alexandros
authors.initials: A
authors.lastname: Briasoulis
authors.affiliation: Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Karolina
authors.initials: K
authors.lastname: Marinescu
authors.affiliation: Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Marian
authors.initials: M
authors.lastname: Mocanu
authors.affiliation: Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Assad
authors.initials: A
authors.lastname: Sattar
authors.affiliation: Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Osama
authors.initials: O
authors.lastname: Qaqi
authors.affiliation: Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Shaun
authors.initials: S
authors.lastname: Cardozo
authors.affiliation: Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Anupama
authors.initials: A
authors.lastname: Kottam
authors.affiliation: Division of Cardiology, Detroit Medical Center, Wayne State University, Detroit, Michigan.
authors.forename: Luis
authors.initials: L
authors.lastname: Afonso
mesh_terms: D000368:Aged; D023921:Coronary Stenosis / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D003937:Diagnosis, Differential; D004452:Echocardiography / Q000379:methods*; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005080:Exercise Test; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity; D054549:Takotsubo Cardiomyopathy / Q000150:complications / Q000000981:diagnostic imaging* / Q000503:physiopathology; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000209:etiology / Q000503:physiopathology
keywords: speckle-tracking imaging; strain imaging; stress-induced cardiomyopathy