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Abstract:
Background: Tako-tsubo cardiomyopathy is an acute form of left ventricular (LV) systolic dysfunction triggered by intense emotional/physical stress. We have previously demonstrated that Tako-tsubo is characterized by profound cardiac energetic impairment with incomplete recovery at short term follow-up (4 months). Due to the persistence of symptoms in a majority of patients, we further hypothesised that impaired cardiac energetics continues during long-term follow-up (> 1 year).
Methods: Sixteen patients [all women, median age 68 years (range 44-81)] with a previously clearly demonstrated diagnosis of Tako-tsubo were invited from the Aberdeen Tako-tsubo registry and 10 healthy volunteers [(all women, median age 62 years (range 44-72)] were recruited from the Cardiology Healthy Volunteer Database. All subjects underwent 31P-Cardiac Magnetic Resonance Spectroscopy (31P-CMRS) and cardiac imaging on a 3T Philips scanner (Best, The Netherlands). 31P-CMRS was analysed with
JMRUi-3 (University of Lyon, France) to derive calculation of the Phosphocreatine/Gamma Adenosine Triphosphate (PCr/ATP) ratio as the gold-standard in vivo assessment of cardiac energetics. Standard cardiac analysis was performed using CMRTools (Cardiovascular Solutions, London, UK). All subjects underwent clinical interview [Minnesota Living with Heart Failure questionnaire (MLWHFQ)] to establish cardiac symptoms.
Results: All but one of the 16 patients complained of ongoing symptoms (chest pain, breathlessness, fatigue) since the acute Takotsubo event (mean MLWHFQ score 14.6). Median follow-up was 23 months (range 13-39 months).
There was no significant difference between the previous Tako-tsubo sufferers and the healthy volunteers with respect to their indexed LV volumes (end-systolic: 27.9± 9.9mls/m2 vs 25.2±4.6mls/m2, p=0.6, end-diastolic: 73.9±15.4 mls/m2 vs 74.2±6.9mls, p=0.9) or LV mass (67±9.1g/m2 vs 65±6.8g, p=0.7) or LV Ejection fraction 62±9.3 vs 65.9±4.3 p=0.2. The resting cardiac energetic status (PCr/ATP ratio) was significantly decreased in Tako-tsubo patients compared with healthy volunteers: 1.3 ± 0.7 vs.1.9 ± 0.5, p=0.03.
Conclusions: The ongoing symptoms in patients who experienced an acute Tako-tsubo episode at least one year previously is accompanied by significant cardiac energetic impairment.
