256 LEFT ATRIAL STRAIN ANALISIS IMPROVES NON-INVASIVE ESTIMATION OF LEFT VENTRICULAR FILLING PRESSURES IN TAKOTSUBO SYNDROME. (15th December 2022)

• Record Type: Journal Article
• Authors: Iannaccone, Giulia; Graziani, Francesca; Del Buono, Marco Giuseppe; Camilli, Massimiliano; Lillo, Rosa; Vecchia, Giulia La; Caffè, Andrea; Pedicino, Daniela; Sanna, Tommaso; Trani, Carlo; Lombardo, Antonella; Lanza, Gaetano Antonio; Montone, Rocco A; Crea, Filippo
• Is Part Of: European heart journal supplements. Volume 24(2022)Supplement K
• Publication Date: 2022-12-15
• Subjects: Cardiology -- Periodicals; Cardiology -- Europe -- Periodicals; 616.12005
• DOI: 10.1093/eurheartjsupp/suac121.194
• Languages: English
• ISSNs: 1520-765X

Abstract

Abstract: Background: Takotsubo syndrome (TTS) is associated with a non-negligible risk of in-hospital complications. Elevated left ventricular filling pressures (LVFP) showed to predict adverse outcomes in this population. Recently, LA reservoir and LA pump strain, demonstrated a close correlation with increased LVFP in unselected patients. The aim of our study is to assess the ability of LA strain analysis to improve non-invasive estimation of LVFP and to predict IH complications in TTS patients. Methods: We prospectively enrolled patients with confirmed TTS diagnosis. LVEDP was assessed invasively at the time of catheterization. Transthoracic echocardiography was performed within 48 hours from hospital admission. In-hospital complications were collected, including occurrence of acute heart failure, death from any cause and life-threatening arrhythmias. Results: A total of 62 patients were analysed (72.2±10.1 years, female 80%). In-hospital complications occurred in 25 (40.3%). Patients who experienced IH complications had higher LVEDP and lower LVEF, LA reservoir strain and LA pump strain values compared to patients without IH complications (all p<0.001). However, at multivariate analysis, only LVEF and LVEDP were independent predictors of worse IH outcomes (p<0.001 and p=0.004, respectively). We observed that in our population the optimal LVEDP cut-off value to predict adverse in-hospital outcome was 24.5 mmHg (sensitivity 80%, specificity 63%). LA reservoir and pump strain resulted to be better predictors of LVEDP >24.5 mmHg in comparison with E/e', LAVi and tricuspid regurgitation (TR) peak velocity. Moreover, the incorporation of LA strain values in a multivariable model including E/e' ratio, LAVi and TR peak velocity to predict a LVEDP>24.5 mmHg led to a significant incremental predictive value (p=0.002). Conclusion: In patients with TTS, lower LA reservoir and pump strain values correlate with increased LVEDP and improve non-invasive estimation of LVFP. LA strain analysis may be an easy tool to individuate subjects at higher risk of in-hospital complications.