Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2014 Aug 4;9(8):e103717.
doi: 10.1371/journal.pone.0103717. eCollection 2014.

Right ventricular function quantification in Takotsubo cardiomyopathy using two-dimensional strain echocardiography

Felix Heggemann  1 , Karsten Hamm  2 , Joachim Brade  3 , Florian Streitner  1 , Christina Doesch  1 , Theano Papavassiliu  1 , Martin Borggrefe  1 , Dariusch Haghi  1
Affiliations

Right ventricular function quantification in Takotsubo cardiomyopathy using two-dimensional strain echocardiography

Felix Heggemann et al. PLoS One. .

Abstract

Aims: This study sought to characterize global and regional right ventricular (RV) myocardial function in patients with Takotsubo cardiomyopathy (TC) using 2D strain imaging.

Methods: We compared various parameters of RV and left ventricular (LV) systolic function between 2 groups of consecutive patients with TC at initial presentation and upon follow-up. Group 1 had RV involvement and group 2 did not have RV involvement.

Results: At initial presentation, RV peak systolic longitudinal strain (RVPSS) and RV fractional area change (RVFAC) were significantly lower in group 1 (-13.2±8.6% vs. -21.8±5.4%, p = 0.001; 30.7±9.3% vs. 43.5±6.3%, p = 0.001) and improved significantly upon follow-up. Tricuspid annular plane systolic excursion (TAPSE) did not differ significantly at initial presentation between both groups (14.8±4.1 mm vs. 17.9±3.5 mm, p = 0.050). Differences in regional systolic RV strain were only observed in the mid and apical segments. LV ejection fraction (LVEF) and LV global strain were significantly lower in group 1 (36±8% vs. 46±10%, p = 0.006 and -5.5±4.8% vs. -10.2±6.2%, p = 0.040) at initial presentation. None of the parameters were significantly different between the 2 groups upon follow-up. A RVPSS cut-off value of >-19.1% had a sensitivity of 85% and a specificity of 71% to discriminate between the 2 groups.

Conclusion: In TC, RVFAC, RVPSS, LVEF and LV global strain differed significantly between patients with and without RV dysfunction, whereas TAPSE did not. 2 D strain imaging was feasible for the assessment of RV dysfunction in TC and could discriminate between patients with and without RV involvement in a clinically meaningful way.

PubMed Disclaimer

Conflict of interest statement

Competing Interests: The authors have declared that no competing interests exist.

Figures

Figure 1
Figure 1. Right ventricular (RV) free wall systolic strain curves in a patient with RV involvement at baseline (A) and upon follow-up (B).
Figure 2
Figure 2. Distribution of RVPSS, TAPSE, RVFAC and LVGLS among patients with (RV+) and without (RV-) right ventricular involvement displayed by dotplots.
RVPSS: right ventricular peak systolic strain, TAPSE: tricuspid annular plane systolic excursion, RVFAC: right ventricular fractional area change, LVGLS: left ventricular global strain.
Figure 3
Figure 3. Correlation of RVPSS, RVFAC, TAPSE and LVGLS with occurrence of RV dysfunction displayed by receiver operating characteristic (ROC) curves.
RVPSS: right ventricular peak systolic strain, TAPSE: tricuspid annular plane systolic excursion, RVFAC: right ventricular fractional area change, LVGLS: left ventricular global strain.
See this image and copyright information in PMC

References

    1. Dote K, Sato H, Tateishi H, Uchida T, Ishihara M (1991) Myocardial stunning due to simultaneous multivessel coronary spasms: a review of 5 cases. J Cardiol 21: 203–214. - PubMed
    1. Heggemann F, Weiss C, Hamm K, Kaden J, Süselbeck T, et al. (2009) Global and regional myocardial function quantification by two-dimensional strain in Takotsubo cardiomyopathy. Eur J Echocardiogr 10: 760–764. - PubMed
    1. Nyui N, Yamanaka O, Nakayama R, Sawano M, Kawai S (2000) 'Tako-Tsubo' transient ventricular dysfunction: a case report. Jpn Circ J 64: 715–719. - PubMed
    1. Nishikawa S, Ito K, Adachi Y, Katoh S, Azuma A, et al. (2004) Ampulla ('takotsubo') cardiomyopathy of both ventricles: evaluation of microcirculation disturbance using 99mTc-tetrofosmin myocardial single photon emission computed tomography and doppler guide wire. Circ J 68: 1076–1080. - PubMed
    1. Kurisu S, Inoue I, Kawagoe T, Ishihara M, Shimatani Y, et al. (2005) Takotsubo-like transient biventricular dysfunction with pressure gradients. Intern Med 44: 727–732. - PubMed

LinkOut - more resources