Reduction in global tissue deformation of the left ventricle as a cause of heart failure and worse quality of life in patients with takotsubo syndrome in the long period of the disease: prospective cohort study

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Abstract

Objective. This study evaluates the severity of chronic heart failure (CHF), ejection fraction (EF), and global contractility of the left ventricle (LV) using Speckle–tracking (STE) in patients with takotsubo syndrome (TS) in the early and late disease stages of the disease and compares these data with an assessment of the quality of life (QoL) of patients.

Material and methods. The study included 60 patients with TS, with a mean age of 65.5±13.4 years. The severity of CHF symptoms was assessed using the SHOKS scale (assessment of the clinical condition in CHF). The Minnesota Questionnaire and the HeartQol questionnaire were used to study QoL. Echocardiography data (ECHOCG) were recorded during the acute period and at discharge from the hospital. In the late disease period, ECHOCG was performed using the STE method. After 1 year, endothelial function was studied using the EndoPAT 2000 device to determine the reactive hyperemia index.

Results. According to the SHOKS scale, the severity of CHF symptoms corresponded to 1–2 functional class (FC) in all patients with TS in the long-term disease; however, before the development of TS, only 15 people had signs of CHF at the level of 1–2 FC. According to ECHOCG, LVEF in patients with TS was 44.5±9.7% at admission, 60.2±7.6% at discharge, 61.6±9.2% after a year, and 60.0±9.0% after 2 years. The average values of global longitudinal and global circular deformation of the left ventricle in patients with TS were 14.0±3.1 and 15.0±4.1%, respectively, after 1 year from disease onset and 12.3±1.9 and 13.1±1.9%, respectively, after 2 years. When comparing the data of the Minnesota Questionnaire and HeartQol questionnaires, QoL in the long-term of ST was significantly lower than the initial one before disease development. Mean reactive hyperemia index values after 1 year were 1.74±0.19.

Conclusion. Despite the complete restoration of LVEF in patients with TS, clinical manifestations of CHF persist. Using the STE technique during the long term, >90% of patients had abnormalities in the global tissue deformity of the left ventricle. These changes may explain the CHF clinical manifestations and QoL decrease in patients with TS during long-term disease.

About the authors

Dmitry S. Evdokimov

Mechnikov North-Western State Medical University

Email: kasabian244@gmail.com
ORCID iD: 0000-0002-3107-1691
SPIN-code: 5260-0063

graduate student

Russian Federation, St. Petersburg

Svetlana A. Boldueva

Mechnikov North-Western State Medical University

Email: svetlanaboldueva@mail.ru
ORCID iD: 0000-0002-1898-084X
SPIN-code: 3716-3375

MD, D. Sci. (Med.), Prof., department head

Russian Federation, St. Petersburg

Valeria S. Feoktistova

Mechnikov North-Western State Medical University

Author for correspondence.
Email: lerissima@yandex.ru
ORCID iD: 0000-0003-4161-3535
SPIN-code: 3714-9090

MD, Cand. Sci. (Med.), Assoc. Prof.

Russian Federation, St. Petersburg

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