Transient left atrial dysfunction is a feature of Takotsubo syndrome

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Abstract

Background

Takotsubo syndrome (TTS) is characterized by a transient left and/or right ventricular dysfunction as a consequence of a distinctive pattern of regional wall motion abnormalities. However, a systematic evaluation of the left atrial (LA) function in patients with TTS is lacking. The aim of the present study was therefore to comprehensively assess LA performance indexes and function in patients with TTS.

Methods

We compared LA function assessed by volumetric indexes derived from fractional volume changes in cardiovascular magnetic resonance (CMR) between 125 TTS patients and 125 patients with anterior ST-segment elevation myocardial infarction (STEMI). Furthermore, recovery of LA performance was evaluated in a subgroup of 20 TTS patients with follow-up CMR data.

Results

Patients with TTS demonstrated a significantly lower total LA emptying fraction (EF) [44% (interquartile range (IQR) 34–53%) versus 51% (IQR 42–56%); p < 0.01], passive LA-EF [21% (IQR 14–30%) versus 24% (IQR 20–29%); p = 0.03] and active LA-EF [29% (IQR 20–38%) versus 35% (28–42%); p < 0.01] compared to patients with anterior STEMI. Among the 20 TTS patients with serial CMR data, the total LA-EF significantly improved from 42% (IQR 29–48%) at the acute stage to 51% (IQR 46–59%) at follow-up ( p < 0.01). Similarly, active LA-EF ( p < 0.01) and passive LA-EF ( p = 0.02) improved significantly as well.

Conclusion

Compared to anterior STEMI, TTS patients demonstrated a significantly decreased LA function during the acute/subacute phase of the disease. However, impairment of LA performance seems to be transient in TTS with recovery during follow-up.

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Most cited references 16

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Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy.

Scott W Sharkey, Denise Windenburg, John Lesser … (2010)

This study was designed to define more completely the clinical spectrum and consequences of stress cardiomyopathy (SC) beyond the acute event. Stress cardiomyopathy is a recently recognized condition characterized by transient cardiac dysfunction with ventricular ballooning. Clinical profile and outcome were prospectively assessed in 136 consecutive SC patients. Patients were predominantly women (n = 130; 96%), but 6 were men (4%). Ages were 32 to 94 years (mean age 68 +/- 13 years); 13 (10%) were 2 months in 5%. Right and/or left ventricular thrombi were identified in 5 patients (predominantly by CMR imaging), including 2 with embolic events. Three patients (2%) died in-hospital and 116 (85%) have survived, including 5% with nonfatal recurrent SC events. All-cause mortality during follow-up exceeded a matched general population (p = 0.016) with most deaths occurring in the first year. In this large SC cohort, the clinical spectrum was heterogeneous with about one-third either male,

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Increasing degrees of left ventricular filling impairment modulate left atrial function in humans.

Antonia Prioli, Paolo Marino, Laura Lanzoni … (1998)

We sought to investigate the changes in atrial reservoir, pump, and conduit functions that are associated with increasing degrees of left ventricular filling impairment. In 13 patients with an impaired relaxation type of filling and in 15 with restrictive patterns, the left atrial volume curve was constructed combining Doppler and 2-dimensional echocardiography. Nine normal subjects served as controls. Left atrial reservoir (defined as [maximum - minimum atrial volume] minus the amount of blood flow reversal in the pulmonary veins with atrial contraction), pump (defined by the volume of blood that enters the ventricle with atrial contraction), and conduit functions (defined as left ventricular filling volume - [left atrial reservoir plus pump volume]) were computed and each expressed as a percentage of ventricular filling volume. The atrial reservoir function was higher in the impaired relaxation group than in normal subjects (49+/-8% vs 38+/-8%, p <0.01) but markedly lower in the restrictive group (27+/-8%, p <0.05). The reverse was true for conduit function, exaggerated in restrictive group (54+/-12% vs 36+/-11% in normal subjects, p <0.01) but minimized in patients with an impaired relaxation type of filling (14+/-9%, p <0.001). The atrial pump contributed 19+/-6% of ventricular filling volume in restrictives, 26+/-3% in normals (p <0.01), and 38+/-4% (p <0.001) in the impaired relaxation group. We conclude that increased atrial response to early-stage left ventricular filling impairment is characterized by augmented reservoir and pump functions, according to a Starling mechanism, which becomes hardly effective at end-stage ventricular dysfunction when the limits of the atrial preload reserve are reached. At this stage, conduit in the atrium takes precedence.

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Intracoronary versus intravenous bolus abciximab during primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction: a randomised trial.

Holger Thiele, Jochen Wöhrle, Rainer Hambrecht … (2012)

Intracoronary administration of an abciximab bolus during a primary percutaneous coronary intervention results in a high local drug concentration, improved perfusion, and reduction of infarct size compared with intravenous bolus application. However, the safety and efficacy of intracoronary versus standard intravenous bolus application in patients with ST-elevation myocardial infarction (STEMI) undergoing this intervention has not been tested in a large-scale clinical trial. The AIDA STEMI trial was a randomised, open-label, multicentre trial. Patients presenting with STEMI in the previous 12 h with no contraindications for abciximab were randomly assigned in a 1:1 ratio by a central web-based randomisation system to intracoronary versus intravenous abciximab bolus (0·25 mg/kg bodyweight) during percutaneous coronary intervention with a subsequent 12 h intravenous infusion 0·125 μg/kg per min (maximum 10 μg/min). The primary endpoint was a composite of all-cause mortality, recurrent infarction, or new congestive heart failure within 90 days of randomisation. Secondary endpoints were the time to occurrence of the primary endpoint, each individual component of that endpoint, early ST-segment resolution, thrombolysis in myocardial infarction (TIMI) flow grade, and enzymatic infarct size. A masked central committee adjudicated the primary outcome and its components. Treatment allocation was not concealed from patients and investigators. This trial is registered with ClinicalTrials.gov, NCT00712101. Between July, 2008, and April, 2011, 2065 patients were randomly assigned intracoronary abciximab (n=1032) or intravenous abciximab (n=1033). Intracoronary, as compared with intravenous abciximab, resulted in a similar rate of the primary composite clinical endpoint at 90 days in 1876 analysable patients (7·0%vs 7·6%; odds ratio [OR] 0·91; 95% CI 0·64-1·28; p=0·58). The incidence of death (4·5%vs 3·6%; 1·24; 0·78-1·97; p=0·36) and reinfarction (1·8%vs 1·8%; 1·0; 0·51-1·96; p=0·99) did not differ between the treatment groups, whereas less patients in the intracoronary group had new congestive heart failure (2·4%vs 4·1%; 0·57; 0·33-0·97; p=0·04). None of the secondary endpoints or safety measures differed significantly between groups. In patients with STEMI undergoing primary percutaneous coronary intervention, intracoronary as compared to intravenous abciximab did not result in a difference in the combined endpoint of death, reinfarction, or congestive heart failure. Since intracoronary abciximab bolus administration is safe and might be related to reduced rates of congestive heart failure the intracoronary route might be preferred if abciximab is indicated. Lilly, Germany. University of Leipzig-Heart Centre. University of Leipzig, Clinical Trial Centre Leipzig, supported by the Federal Ministry of Education and Research (BMBF). Copyright Â© 2012 Elsevier Ltd. All rights reserved.

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Author and article information

Contributors

Thomas Stiermaier: thomas.stiermaier@uksh.de

Tobias Graf: tobias.graf@uksh.de

Christian Möller: christian.moeller@uksh.de

Charlotte Eitel: charlotte.eitel@uksh.de

Jakob Ledwoch: jakob.ledwoch@uksh.de

Steffen Desch: steffen.desch@uksh.de

Matthias Gutberlet: matthias.gutberlet@helios-kliniken.de

Gerhard Schuler: gerhard.schuler@helios-kliniken.de

Holger Thiele: holger.thiele@uksh.de

Ingo Eitel: +49 451 500 44501 , ingo.eitel@uskh.de , ingo.eitel@uksh.de

Journal

Journal ID (nlm-ta): J Cardiovasc Magn Reson

Journal ID (iso-abbrev): J Cardiovasc Magn Reson

Title: Journal of Cardiovascular Magnetic Resonance

Publisher: BioMed Central (London )

ISSN (Print): 1097-6647

ISSN (Electronic): 1532-429X

Publication date (Electronic): 6 February 2017

Publication date PMC-release: 6 February 2017

Publication date Collection: 2017

Volume: 19

Electronic Location Identifier: 15

Affiliations

[1 ]GRID grid.37828.36, , University Heart Center Lübeck, Medical Clinic II (Cardiology/Angiology/Intensive Care Medicine), University Hospital Schleswig-Holstein, ; Ratzeburger Allee 160, 23538 Lübeck, Germany

[2 ]German Center for Cardiovascular Research (DZHK), Partner Site Hamburg/Kiel/Lübeck, Lübeck, Germany

[3 ]ISNI 0000 0001 2230 9752, GRID grid.9647.c, Department of Diagnostic and Interventional Radiology, , University of Leipzig - Heart Center, ; Leipzig, Germany

[4 ]ISNI 0000 0001 2230 9752, GRID grid.9647.c, Department of Internal Medicine/Cardiology, , University of Leipzig - Heart Center, ; Leipzig, Germany

Article

Publisher ID: 328

DOI: 10.1186/s12968-017-0328-8

PMC ID: 5292816

PubMed ID: 28162089

SO-VID: 099f9cf2-9345-4d14-8e45-4a2f152a1a70

License:

Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License ( http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver ( http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.

History

Date received : 20 October 2016

Date accepted : 17 January 2017

Custom metadata

ScienceOpen disciplines: Cardiovascular Medicine

Keywords: takotsubo,stress cardiomyopathy,left atrial function,cardiovascular magnetic resonance

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ScienceOpen disciplines: Cardiovascular Medicine

Keywords: takotsubo, stress cardiomyopathy, left atrial function, cardiovascular magnetic resonance

Transient left atrial dysfunction is a feature of Takotsubo syndrome

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Abstract

Background

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Conclusion

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Karger: Cardiovascular System

Most cited references 16

Natural history and expansive clinical profile of stress (tako-tsubo) cardiomyopathy.

Increasing degrees of left ventricular filling impairment modulate left atrial function in humans.

Intracoronary versus intravenous bolus abciximab during primary percutaneous coronary intervention in patients with acute ST-elevation myocardial infarction: a randomised trial.

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