Tako-Tsubo cardiomyopathy (TTC) is characterized by transient stress induced transient left ventricular (LV) dysfunction. Right ventricular (RV) involvement may occur and is associated with bad outcome. Assessment of RV function may be difficult using echo. Velocity vector imaging (VVI) is a new echo technology that measures myocardial velocity and deformation using 2D speckle tracking. The aim of this study was to assess RV involvement in TTC by VVI.

We prospectively studied 80 pts divided in 3 groups: 30 pts with TTC (group 1), 30 pts with CAD defined as a documented LAD occlusion (group 2) and a control group (n=20, group 3). Groups 2 and 3 were age and gender matched with group 1. RV function was assessed by RV angiography or MRI, allowing the calculation of RV ejection fraction (RVEF) and was considered as our gold standard. We systematically performed echocardiography, with the use of VVI technology, allowing to measure peak velocity (V), peak strain (S) and peak strain rate (SR) in basal, mid and apical RV free wall (FW) in apical 4-chamber view. RV systolic function was also assessed by the RV fractional area change (FAC) measured in apical 4-chamber view.

Prevalence of RV involvement in TTC was 35% and NYHA class was significantly higher (p<0.05) and LVEF was lower (p=0.03) as compared to pts with TTC but without RV involvement. Values of V, S and SR in basal, mid and apical right ventricular FW were significantly lower in group 1 as compared to groups 2 and 3 (p<0.02 for basal FW and p<0.01 for mid and apical FW). Strong correlation was found between RVEF and global values of V (r=0.88, p<0.0001), whereas correlation between RVEF and FAC was weak (r=0.47, p=0.04). In TTC, RV dysfunction was found in all pts (n=30 using VVI versus only 14 pts using the FAC method, p<0.0001).

Our study suggests that VVI could be of interest for the assessment of RV involvement in TTC, allowing to individualize high-risk pts.