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Left ventricular mechanics in the acute phase of Takotsubo cardiomyopathy: distinctive ballooning patterns translate into different diastolic properties

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Abstract

Although apical and midventricular Takotsubo cardiomyopathies (TTCs) share common triggers and pathophysiological features, little is known about the potential differences in left ventricular (LV) mechanistic properties between these TTC phenotypes. We sought to investigate whether LV systolic and/or diastolic function, as assessed invasively by left heart catheterization (LHC), differ according to ballooning patterns in the acute phase of TTC. One hundred and fourteen TTC patients were retrospectively identified between January 2009 and December 2015 at the University Hospital of Strasbourg, France. A comprehensive list of LV quantitative parameters was derived from LHC analysis for each patient. We examined 2 groups of patients according to ballooning patterns in the acute phase of TTC: patients with apical ballooning (“Apical group”; n = 76) and those with midventricular ballooning (“Midventricular group”; n = 38). LV minimal diastolic pressure (8.72 ± 6.72 vs. 5.02 ± 6.08 mmHg; p = 0.004), LV end diastolic pressure (23.11 ± 8.32 vs. 18.84 ± 8.06 mmHg; p = 0.01), and LV diastolic stiffness (LV stiffness 1: 0.29 ± 0.23 vs. 18.84 ± 8.06 mmHg/mL; p = 0.04—LV stiffness 2: 0.16 ± 0.08 vs. 0.12 ± 0.05 mmHg/mL; p = 0.005) were significantly higher in patients with apical TTC than in the midventricular group. Concomitantly, these findings were associated with significantly higher BNP levels in the apical group (923.91 ± 1164.53 vs. 418.71 ± 557.75 pg/mL; p = 0.004) than in the midventricular group. In the acute phase of stress cardiomyopathy, the classic apical form of TTC is associated with poorer diastolic function compared to the midventricular ballooning variant, as assessed through direct invasive hemodynamic measurements using LHC.

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Acknowledgements

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Funding

This research was supported by GERCA (Groupe pour l'Enseignement, la prévention et la Recherche Cardiologique en Alsace).

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Authors and Affiliations

  1. Department of Cardiology, University Hospital of Strasbourg, 1 Place de l’Hôpital BP 426, 67091, Strasbourg Cedex, France

    Nathan Messas, Antonin Trimaille, Benjamin Marchandot, Kensuke Matsushita, Marion Kibler, Sébastien Hess, Laurence Jesel, Patrick Ohlmann & Olivier Morel

  2. Department of Medicine, Montreal Heart Institute, 5000, Bélanger, Montreal, QC, H1T 1C8, Canada

    Nathan Messas, Guillaume Marquis-Gravel & E. Marc Jolicoeur

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  1. Nathan Messas
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  2. Antonin Trimaille
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  3. Benjamin Marchandot
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  4. Kensuke Matsushita
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  5. Marion Kibler
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Correspondence to Antonin Trimaille.

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Messas, N., Trimaille, A., Marchandot, B. et al. Left ventricular mechanics in the acute phase of Takotsubo cardiomyopathy: distinctive ballooning patterns translate into different diastolic properties. Heart Vessels 35, 537–543 (2020). https://doi.org/10.1007/s00380-019-01510-1

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  • DOI: https://doi.org/10.1007/s00380-019-01510-1

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