"Takotsubo Effect" In Patients With St Segment Elevation Myocardial Infarction

Background Myocardial infarction can be a trigger of Takotsubo syndrome. We recently characterized imaging features of acute myocardial infarction-induced Takotsubo syndrome ("Takotsubo effect"). In this study, we investigate diagnostic and prognostic implications of Takotsubo effect in patients with anterior wall ST-segment elevation myocardial infarction. Methods We enrolled 111 consecutive patients who developed anterior wall ST-segment elevation myocardial infarction and received percutaneous coronary intervention, and studied systolic/diastolic function, hemodynamic consequences, adverse cardiac events, as well as 30-day and five-year outcomes in patients with and without Takotsubo effect. Results Patients with Takotsubo effect showed significantly worse average peak systolic longitudinal strain (-9.5 +/- 2.6% vs -11.1 +/- 3.6%,p = 0.038), left ventricular ejection fraction (38.5 +/- 6.8% vs 47.7 +/- 8.7%,p = 0.000) and myocardial performance index (0.54 +/- 0.17 vs 0.37 +/- 0.15,p = 0.000) within 48 h of myocardial infarction. There was no significant difference between the two groups in diastolic ventricular filling pressures, hemodynamic consequences, and 30-day rehospitalization and mortality (Gehan-Breslow-Wilcoxon test:p = 0.157). However, patients with Takotsubo effect developed more major adverse cardiac events (log-rank test:p = 0.019) when tested at the five-year follow-up. Cox regression analysis revealed that age, hypotension, tricuspid annular plane systolic excursion, and Takotsubo effect were independent prediction factors for five-year major adverse cardiac events. The Doppler/tissue Doppler parameter E/e' correlated with MACE only in patients without Takotsubo effect. Conclusion Takotsubo effect secondary to anterior ST-segment elevation myocardial infarction predicts a worse long-term prognosis.