On The Nature of Transient Left Atrial Dysfunction in Patients with Takotsubo Syndrome

One of the hallmarks of takotsubo syndrome (TTS) is the regional contraction abnormalities transiently affecting the left and occasionally the right ventricles. One wonders whether the left and right atria are involved in TTS, and if not, why the atria are spared. A recent relevant paper [1] rekindled these thoughts about a possible left atrial (LA) involvement in TTS. The authors compared 125 patients with TTS with 125 patients admitted with an anterior ST-segment elevation myocardial infarction, employing cardiovascular magnetic resonance (CMR)-based conventional LA volumetric indices, derived from fractional volume changes, and found lower total LA emptying fraction (EF), passive LAEF, and active LA-EF in the former. Also in a subgroup of 20 of their TTS patients, who underwent a repeated CMR at follow-up, they detected recovery of LA function, as shown by the significant improvement in all 3 LA volumetric indices, between the CMR assessments carried out at the initial acute/subacute phase of the illness and at follow-up at a “median 3.3 months (IQR 3-5months) after the initial event” [1].