Left ventricular myocardial function assessed by three-dimensional speckle tracking echocardiography in Takotsubo cardiomyopathy

Background We aimed to investigate left ventricular (LV) functional recovery in Takotsubo cardiomyopathy (TC) using three-dimensional (3D) speckle tracking echocardiography. Methods Twenty-one patients with TC who underwent routine and 3D echocardiography as well as electrocardiography were enrolled. 3D images were analyzed to measure 3D radial strain and area tracking (area change of each LV segment). Postsystolic shortening (PSS) or thickening (PST) was defined as a further shortening or thickening occurred after the end-systole. 3D echocardiography and ECG were repeated at 4 weeks and 6 months later. Results Mean age was 70.9 +/- 11.1 years, and 18 (86%) patients were female. All patients presented classical type of TC with apical ballooning. LV ejection fraction (EF) improved from 49.9 +/- 7.2 to 64.9 +/- 6.0% (P<.001) at 4 weeks without segmental wall-motion abnormality. However, PSS or PST still existed in 43% of LV segments, and electrocardiographic abnormality was also observed in 51% at 4 weeks and disappeared at 6 months. Mean 3D radial strain decreased from baseline to 6 months at base (36.1 +/- 19.6 vs 28.0 +/- 12.6%, P=.04), whereas it increased at mid (16.2 +/- 7.2 vs 28.7 +/- 9.1%, P=.03) and the apex (8.0 +/- 4.4 vs 21.2 +/- 7.9%, P<.001). Mean area tracking increased from baseline to 6 months at mid and apex (-28.5 +/- 9.5 vs -44.5 +/- 9.6%, P<.001 for mid, and -24.2 +/- 13.0 vs -42.9 +/- 16.8%, P=.002 for the apex), while it did not change at base (-37.0 +/- 8.9 vs -41.9 +/- 9.6%, P=NS). Conclusions Patients with TC show abnormal wall motion during acute phase. Even after LV wall-motion recovery, subtle abnormalities of regional LV function appear to persist at 4 weeks followed by normalization at 6 months.