Left Ventricular Twist and the "Rigid Body Rotation" Pattern in Patients Treated with Anthracyclines or Anti-HER2.

Background: During the physiological cardiac cycle, the helix orientation of the muscle fibres induces the rotation of the apex relative to the base of the left ventricular (LV). In heart failure, LV torsion is impaired, and rotation at basal and apical levels occurs in the same direction, a phenomenon called rigid body rotation (RBR). We aimed to evaluate whether the RBR pattern and GLS together could improve the diagnosis of cardiotoxicity in patients treated with anthracyclines and/or anti-HER2. Methods: With an observational, retrospective study involving 175 patients (mean age 55 ± 12 years, 94% females), we evaluated the development of cancer therapeutic-related cardiac dysfunction (CTRCD) defined according to ESC guidelines. We characterised LV dysfunction by echocardiographic standard and speckle-tracking (GLS and RBR pattern) measurements. Patients with a previous diagnosis of structural heart disease or atrial fibrillation were excluded. Results: At the time of enrolment, the chemotherapy regimen included trastuzumab (96%), pertuzumab (21%), and anthracyclines (13%). Twenty-two patients (12.5%) developed cardiotoxicity, and thirteen patients developed an RBR within 6 months of follow-up. In all cases, the RBR pattern was associated with cardiotoxicity (p < 0.001), reporting an optimal specificity but poor sensitivity at three and six months. However, the addition of the RBR pattern to the global longitudinal strain (GLS) ≥ -16% increased the odds ratio (OR) from 25.6 to 32.6 at three months and from 32.5 to 49.6 at six months rather than GLS alone. Conclusions: The RBR pattern improves the diagnostic accuracy of GLS for the detection of cardiotoxicity secondary to anthracyclines and anti-HER2-based treatments.

Transient QRS amplitude attenuation is associated with clinical recovery in patients with takotsubo cardiomyopathy.

BACKGROUND/OBJECTIVES: Low voltage QRS complexes (LQRSV) and amplitude attenuation of QRS voltage (AAQRS) have been described in takotsubo (TC) patients, and postulated as valuable pre-angiographic markers. The aim of this observational study is to evaluate potential diagnostic and prognostic features of QRS amplitude in TC and acute coronary syndrome (ACS) patients. METHODS: Fifty-eight patients with TC were matched with 58 patients with ACS according to age, gender, and presence or absence of ST elevation at hospital admission. A 12-lead ECG was recorded within 12h after symptoms onset, the day after coronary angiography (CA) and before hospital discharge. When available, ECGs prior and subsequent to the acute event were also collected. RESULTS: QRS amplitude showed a time related trend, with a first phase characterized by an initial decrease in amplitude in both groups and a second phase, with a progressive recovery of QRS amplitude in TC patients up to pre-event levels, while QRS amplitude in ACS patients remained substantially unchanged from admission onwards. Rise in AAQRS during hospitalization showed a positive linear association with systolic function recovery and both troponin I and CK-MB decrease (all p<0.01) in TC patients. A 20% increase of mean AAQRS from admission is able to predict LVEF recovery and troponin I and CK-MB normalization in TC patients with good sensitivity and specificity. CONCLUSIONS: LQRSV and AAQRS are not reliable in differentiating ACS from TC. However, QRS amplitude attenuation in TC is transient, and is linearly associated with systolic function recovery and cardiac biomarkers normalization.

Differences and similarities of repolarization patterns during hospitalization for Takotsubo cardiomyopathy and acute coronary syndrome.

Takotsubo cardiomyopathy (TC) is characterized by an acute transient left ventricular systolic dysfunction mimicking acute coronary syndrome (ACS) without significant coronary stenosis. The aim of this study was to examine the electrocardiographic repolarization patterns of TC and ACS and to compare them from hospital admission to hospital discharge. Forty-five patients with TC were matched with 45 patients with ACS according to age, gender, and presence or absence of ST elevation at hospital admission. A complete 12-lead electrocardiography was performed within 12 hours after symptoms onset and then repeated after 3, 5, and 7 days. All patients underwent coronary angiography, and patients with ACS also underwent percutaneous revascularization. Within 12 hours from the symptoms' onset, patients with TC had a significantly fewer number of leads with ST elevation and a significantly more number of leads with T-wave inversion. These differences, however, were not present after 72 hours and a similar trend was seen over time during the 7-day follow-up. Patients with TC had a significant longer corrected QT interval at admission and during the whole follow-up. In conclusion, in the electrocardiograms collected 12 hours within symptoms onset, patients with TC and those with ACS showed significant differences in cardiac repolarization. However, the number of leads with either ST-segment deviation or T-wave alterations in patients with TC soon matched the ACS group undergoing percutaneous revascularization. In contrast, corrected QT interval was persistently longer in patients with TC and, despite a similar reduction in length over time in both groups, it was still significantly longer after 7 days.