Left atrial strain analysis improves left ventricular filling pressures non-invasive estimation in the acute phase of Takotsubo syndrome

Giulia Iannaccone; Francesca Graziani; Marco Giuseppe Del Buono; Massimiliano Camilli; Rosa Lillo; Andrea Caffè; Francesco Moroni; Giulia La Vecchia; Daniela Pedicino; Tommaso Sanna; Carlo Trani; Antonella Lombardo; Gaetano Antonio Lanza; Massimo Massetti; Filippo Crea; Rocco A Montone

doi:10.1093/ehjci/jead045

Left atrial strain analysis improves left ventricular filling pressures non-invasive estimation in the acute phase of Takotsubo syndrome

Eur Heart J Cardiovasc Imaging. 2023 May 31;24(6):699-707. doi: 10.1093/ehjci/jead045.

Authors

Giulia Iannaccone^{1

2}, Francesca Graziani², Marco Giuseppe Del Buono^{1

2}, Massimiliano Camilli^{1

2}, Rosa Lillo^{1

2}, Andrea Caffè¹, Francesco Moroni³, Giulia La Vecchia¹, Daniela Pedicino², Tommaso Sanna^{1

2}, Carlo Trani^{1

2}, Antonella Lombardo^{1

2}, Gaetano Antonio Lanza^{1

2}, Massimo Massetti^{1

2}, Filippo Crea^{1

2}, Rocco A Montone²

Affiliations

¹ Department of Cardiovascular and Pulmonary Sciences, Catholic University of the Sacred Heart, Largo Francesco Vito, 1, Rome 00168, Italy.
² Department of Cardiovascular Medicine, Fondazione Policlinico Universitario A. Gemelli IRCCS, Rome, Italy.
³ Pauley Heart Center; Wright Center for Clinical and Translational Research, Virginia Commonwealth University, 1200 E Marshall St, Richmond, VA 23298, USA.

Abstract

Aims: The aim of our study is to assess the ability of left atrial (LA) strain values to improve left ventricular and diastolic pressure (LVEDP) non-invasive estimation as compared with traditional echocardiographic indexes in the acute phase of Takotsubo syndrome (TTS) and to predict adverse in-hospital outcomes in this population.

Methods and results: Consecutive TTS patients were prospectively enrolled. Left ventricular and diastolic pressure was measured at the time of catheterization. Transthoracic echocardiography was performed within 48 h from hospital admission. In-hospital complications (acute heart failure, death from any cause, and life-threatening arrhythmias) were collected. A total of 62 patients were analysed (72.2 ± 10.1 years, female 80%) and in-hospital complications occurred in 25 (40.3%). Left ventricular and diastolic pressure mean value was 24.53 ± 7.92 mmHg. Left atrial reservoir and pump strain values presented higher correlation with LVEDP (r -0.859, P < 0.001 and r -0.848, P < 0.001, respectively) in comparison with E/e ' ratio, left atrial volume index (LAVi), and tricuspid regurgitation (TR) peak velocity. In addition, at receiver-operating characteristic curve analysis, LA reservoir and pump strain resulted to be better predictors of LVEDP above the mean of our population [0.909 (95% CI 0.818-0.999, P < 0.001) and 0.889 (95% CI 0.789-0.988, P < 0.001)], respectively] as compared with E/e' ratio, LAVi, and TR peak velocity.Finally, LA reservoir strain resulted to be an independent predictor of worse in-hospital outcomes, together with LVEDP and left ventricular ejection fraction (all P < 0.001).

Conclusion: In our study, lower LA reservoir and pump strain values were better predictors of LVEDP as compared with traditional echocardiographic indexes in the acute phase of TTS syndrome. Moreover, LA reservoir strain was an independent predictor of adverse in-hospital outcomes.

Keywords: LA strain analysis; LVEDP; Takotsubo syndrome; left ventricular filling pressure.

MeSH terms

Atrial Fibrillation*
Cardiac Catheterization
Female
Heart Atria / diagnostic imaging
Humans
Stroke Volume
Takotsubo Cardiomyopathy* / diagnostic imaging
Ventricular Dysfunction, Left*
Ventricular Function, Left