Purpose .– To assess left ventricular (LV) twist mechanics in patients (pts) with tako-tsubo syndrome (TTS).

Methods .– Two-dimensional strain and LV twist by speckle tracking echocardiography (echoPACK 7 version 108) was performed in 10 consecutive pts with typical TTS according to the Mayo clinic criteria (77 ± 10 years, 100% women, and mean LVEF 44 ± 10%), at the acute phase (within 24 h after symptom onset) and after recovery (one month later). Ten healthy control (C) pts matched for age and sex (mean LVEF 72 ± 7%), and 10 pts with acute anterior myocardial infarction (MI) treated by successful primary angioplasty 24 h before, matched for LVEF, were compared to TTS pts. LV twist was assessed using the parasternal basal and apical short-axis planes, and defined as the net difference in degrees of apical (Ar) and basal rotation (Br). LV torsion was defined as LV twist normalized for diastolic LV longitudinal length. Peak systolic and early diastolic, apical (As and Ad) and basal (Bs and Bd) rotation rate, and LV twisting rate (TR) and untwisting rate (UR) (in°/s) were derived from rotational and twist curves. The time sequences were normalized to the percentage of systolic duration.

Results .– At the acute phase, Br, Bs, Bd were not significantly different between groups (all, P = NS). LV twist and torsion (1.2 ± 1.1 °/cm vs. 2.8 ± 1.1 °/cm) were significantly reduced in pts with TTS as a result of severely impaired Ar (4 ± 5° vs. 13 ± 5°) when compared to C pts (all, P < 0.01). Pts with MI displayed intermediate values ( P = NS vs. TTS, and P < 0.05 vs. C). Abnormal reversed apical rotation (clockwise when seen from the apex) was seen in 3 pts (30%) with TTS vs. none in the other groups. In pts with TTS, As, Ad, TR and UR were significantly reduced when compared to C ( P < 0.05 vs. C, and P = NS vs. MI). Furthermore, in pts with TTS, there was a significant correlation between plasma NT-proBNP and Ar ( r = −0.6), LV twist, LV torsion ( r = −0.8), and time to Ar ( r = 0.8) (all, P < 0.05) but not with Br ( P = NS), At follow-up, LV twist, torsion, and Ar improved significantly in TTS and MI pts (all, P < 0.05 vs. acute phase), whereas the magnitude of improvement was higher in TTS pts (all changes, P < 0.05 vs. MI) who had final values similar to C (all, P = NS). In pts with TTS, As, Ad, TR, and UR also improved significantly at follow-up (all, P < 0.05).

Conclusion .– LV twist mechanics is significantly impaired in pts with TTS due to a severe reduction of apical function. This impairment is correlated to the increased LV wall stress and is entirely reversible.