Optimal Heart Rate Control Improves Long-Term Prognosis of Decompensated Heart Failure with Reduced Ejection Fraction.

Background and Objectives: An elevated heart rate is an independent risk factor for cardiovascular disease; however, the relationship between heart rate control and the long-term outcomes of patients with heart failure with reduced ejection fraction (HFrEF) remains unclear. This study explored the long-term prognostic importance of heart rate control in patients hospitalized with HFrEF. Materials and Methods: We retrieved the records of patients admitted for decompensated heart failure with a left ventricular ejection fraction (LVEF) of ≤40%, from 1 January 2005 to 31 December 2019. The primary outcome was a composite of cardiovascular death or hospitalization for heart failure (HHF) during follow-up. We analyzed the outcomes using Cox proportional hazard ratios calculated using the patients' heart rates, as measured at baseline and approximately 3 months later. The mean follow-up duration was 49.0 ± 38.1 months. Results: We identified 5236 eligible patients, and divided them into five groups on the basis of changes in their heart rates. The mean LVEFs of the groups ranged from 29.1% to 30.6%. After adjustment for all covariates, the results demonstrated that lesser heart rate reductions at the 3-month screening period were associated with long-term cardiovascular death, HHF, and all-cause mortality (p for linear trend = 0.033, 0.042, and 0.003, respectively). The restricted cubic spline model revealed a linear relationship between reduction in heart rate and risk of outcomes (p for nonlinearity > 0.2). Conclusions: Greater reductions in heart rate were associated with a lower risk of long-term cardiovascular death, HHF, and all-cause mortality among patients discharged after hospitalization for decompensated HFrEF.

Value of the high-sensitivity troponin T assay for diagnosis of acute myocardial infarction in patients with and without renal insufficiency.

BACKGROUND: Cardiac troponins are important markers for diagnosis of acute myocardial infarction (AMI) in general population; however, chronically-elevated troponins levels are often seen in patients with renal insufficiency, which reduce their diagnostic accuracy. The aim of our study was to access the diagnostic values of initial high-sensitive cardiac troponin T (hs-cTnT) and relative change of hs-cTnT for AMI in patients with and without renal insufficiency. METHODS: Cardiac care unit patients with elevated hs-cTnT levels in 2017-2018 were enrolled. Receiver operating characteristic (ROC) curves were used to evaluate initial hs-cTnT levels and relative changes after 3 h of enrollment for diagnosis of AMI in patients with estimated glomerular filtration rate (eGFR) < 60 mL/min/1.73 m2 (low), and eGFR ≥ 60 mL/min/1.73 m2 (normal). RESULTS: Of 359 patients, 240 patients had low eGFR, and 119 patients had normal eGFR. The area under the ROC curve (AUC) for the initial hs-cTnT levels was 0.58 (95% CI, 0.5-0.65, p = 0.053) among patients with low eGFR and 0.54 (95% CI, 0.4-0.67, p = 0.612) among patients with normal eGFR. AUCs for relative changes of hs-cTnT were 0.82 (95% CI, 0.76-0.88, p < 0.001) in patients with low eGFR and 0.82 (95% CI, 0.71-0.91, p < 0.001) in patients with normal eGFR. Optimal cutoff values for the relative changes in hs-cTnT were 16% and 12% in patients with low eGFR and normal eGFR, respectively. CONCLUSIONS: Relative changes in hs-cTnT levels had better diagnostic accuracy than initial hs-cTnT levels.

Echocardiographic Evaluation of Left Atrial Function to Discriminate Non-Valvular Atrial Fibrillation Development in Patients with Apical Hypertrophic Cardiomyopathy.

BACKGROUND: Data is limited on baseline left atrial (LA) myocardial mechanics between apical hypertrophic cardiomyopathy (ApHCM) patients who develop non-valvular atrial fibrillation (NVAF) during follow-up and those who do not. METHODS: This retrospective study investigated the clinical outcomes of consecutive patients newly diagnosed with ApHCM between August 2011 and July 2014 who were followed-up for at least 3 years. The patients underwent 12-lead surface electrocardiography and/or 24-hour Holter electrocardiography at least once a year. The patients were divided into two groups, namely those who did or did not exhibit NVAF during follow-up, respectively. The baseline clinical and echocardiographic data of the two groups were compared. RESULTS: Twenty patients were studied, five of whom were lost to follow-up. Of the remaining 15 ApHCM patients, seven developed NVAF. No differences were observed in the clinical characteristics of the two groups. However, for the echocardiographic data, the NVAF development group exhibited a larger LA volume and impaired LA reservoir, conduit and booster functions. The NVAF development group also showed lower peak LA strain and stiffer left atrium. The LA volume, function, global strain and stiffness were all statistically associated with NVAF development. Among these parameters, a LA conduit function of ≤ 24.9% was found to be the best parameter to discriminate NVAF development. CONCLUSIONS: The baseline LA function was impaired in the ApHCM patients who subsequently developed NVAF during follow-up. A LA conduit function of ≤ 24.9% was strongly associated with NVAF development.

Aliskiren attenuates the effects of interleukin-6 on endothelial nitric oxide synthase and caveolin-1 in human aortic endothelial cells.

Renin inhibitors enhance endothelial nitric oxide synthase (eNOS) bioavailability and have protective effects on endothelial function and atherosclerotic changes. This study was designed to investigate whether aliskiren attenuates the effects of interleukin-6 (IL-6) on eNOS and the eNOS-caveolin-1 interaction in human aortic endothelial cells (HAECs). In this study, we examined the effects of pretreatment with aliskiren on the changes of IL-6-induced expression and activation of eNOS and caveolin-1 in cultured HAECs. IL-6 inhibited and aliskiren increased the phosphorylation of eNOS at Ser1177; however, eNOS protein and mRNA expression were not changed. Pretreatment with aliskiren attenuated the inhibitory effects of IL-6 on eNOS phosphorylation and nitric oxide production. IL-6 increased the phosphorylation of caveolin-1 at Tyr14 without affecting the caveolin-1 protein and mRNA expression. Pretreatment with aliskiren attenuated the effects of IL-6 on caveolin-1 phosphorylation. The binding of eNOS and caveolin-1, as determined by a co-immunoprecipitation assay, was increased by IL-6 treatment and decreased by aliskiren pretreatment. Furthermore, treatment with short interfering RNA of the extracellular signal-regulated kinase gene reversed the effects of IL-6 and aliskiren on eNOS and caveolin-1. In conclusion, aliskiren attenuates the inhibitory effects of IL-6 on eNOS phosphorylation and nitric oxide production and IL-6 induced caveolin-1 phosphorylation. In addition, aliskiren reverses the effects of IL-6 on the eNOS-caveolin-1 interaction.

Thin-film vertical-type AlGaInP LEDs fabricated by epitaxial lift-off process via the patterned design of Cu substrate.

In this study, the thin-film vertical-type AlGaInP LEDs on Cu substrates were fabricated. By performing the epitaxial lift-off (ELO) process, the LED device can be transferred from GaAs to Cu substrate. Then the GaAs substrate was separated and the ELO-LED was completed. To overcome the drawback of crack formation in the epilayer during the ELO process, various patterned Cu substrates were designed. Moreover, the finite element method was used to simulate the stress distribution in the LED sample during the ELO process. From the simulation results, an optimum structure of patterned Cu substrate was obtained since its maximum stress can be confined to the chip edges and the stress was decreased significantly during the ELO process, resulting in an apparent reduction of crack generation after separating the GaAs substrate. This optimum patterned Cu substrate was employed for the fabrication of ELO-LED. In addition, the chemical etching process was also used to etch the GaAs substrate, and this device transferred to Cu substrate was denoted as CE-LED. Based on the measurements of device performances, the forward voltages (@350 mA) of the CE-LED and ELO-LED were measured to be 2.20 and 2.29 V, while the output powers (@350 mA) of these two devices were 49.9 and 48.2 mW, respectively. Furthermore, the surface temperatures (@350 mA) of these two samples were 46.9-48.3 and 45.2-47.0 °C, respectively. Obviously, the device characteristics of the ELO-LED are very similar to those of the CE-LED. It confirms that the design of patterned Cu substrate is very helpful to obtain the thin-film vertical-type AlGaInP LEDs. Additionally, via the ELO process, the separated GaAs substrate can be reused for production cost down.

Optical and Electrical Properties of AlGaN-Based High Electron Mobility Transistors and Photodetectors with AlGaN/AlN/GaN Channel-Stacking Structure.

High channel current of the high electron mobility transistors (HEMTs) and high relative responsivity of the photodetectors (PDs) were demonstrated in the AlGaN/AlN/GaN channel-stacking epitaxial structures. The interference properties of the X-ray curves indicated high-quality interfaces of the conductive channels. The AlGaN/AlN/GaN interfaces were observed clearly in the transmission electron microscope micrograph. The saturation I ds currents of the HEMT structures were increased by adding a number of channels. The conductive properties of the channel-stacking structures corresponded to the peaks of the transconductance (g m) spectra in the HEMT structures. The depletion-mode one- and two-channel HEMT structures can be operated at the cutoff region by increasing the reverse V gs bias voltages. Higher I ds current in the active state and lower current in the cutoff state were observed in the two-channel HEMT structure compared with one- and three-channel HEMT structures. For the channel-stacking metal-semiconductor-metal photodetector structures, the peak responsivity was observed at almost 300 nm incident monochromic light, which was increased by adding a number of channel layers. The channel current of the HEMT devices and the photocurrent in the PD devices were increased by adding a number of two-dimensional electron gas (2DEG) channels. By using a flat gate metal layer, the two-channel AlGaN/AlN/GaN HEMT structures exhibited a high I ds current, a low cutoff current, and a high peak g m value and have the potential for GaN-based power devices, fast portable chargers, and ultraviolet PD applications.

Pulsed laser deposition of hexagonal GaN-on-Si(100) template for MOCVD applications.

Growth of hexagonal GaN on Si(100) templates via pulsed laser deposition (PLD) was investigated for the further development of GaN-on-Si technology. The evolution of the GaN growth mechanism at various growth times was monitored by SEM and TEM, which indicated that the GaN growth mode changes gradually from island growth to layer growth as the growth time increases up to 2 hours. Moreover, the high-temperature operation (1000 °C) of the PLD meant no significant GaN meltback occurred on the GaN template surface. The completed GaN templates were subjected to MOCVD treatment to regrow a GaN layer. The results of X-ray diffraction analysis and photoluminescence measurements show not only the reliability of the GaN template, but also the promise of the PLD technique for the development of GaN-on-Si technology.

Differences of left ventricular systolic deformation in hypertensive patients with and without apical hypertrophic cardiomyopathy.

BACKGROUND: We tested the hypothesis that the apical myocardial mechanics differ from those of other ventricular segments in hypertensive patients with and without apical hypertrophic cardiomyopathy (ApHCM). METHODS: We retrospectively studied hypertensive patients with and without ApHCM. Left ventricular longitudinal, circumferential, and radial strains were examined by two-dimensional speckle-tracking echocardiography at the basal, middle, and apical walls of the parasternal short-axis and apical 2-, 3- and 4-chamber views. RESULTS: Fourteen consecutive patients with hypertension and ApHCM and 14 patients with hypertension without ApHCM were studied. Lower mitral annular peak systolic velocity and greater diastolic dysfunction were present in hypertensive patients with ApHCM than in hypertensive patients without ApHCM. Compared with hypertensive patients without ApHCM, hypertensive patients with ApHCM had significantly lower apical longitudinal (-13.9% vs -21.9%, p = 0.010) and radial strains (4.4% vs 11.5%, p = 0.017) without the base-to-apex gradient. The global longitudinal (-15.6% vs -18.8%, p = 0.027) and circumferential strains (-16.1% vs -19.2%, p = 0.019) were significantly lower in hypertensive patients with ApHCM than in hypertensive patients without ApHCM. Among systolic parameters, the global longitudinal strain was independently associated with hypertension with ApHCM (odds ratio, 1.457; 95% confidence interval, 1.002-2.119; p = 0.049). CONCLUSIONS: Reduced apical longitudinal and radial strains without a base-to-apex gradient were present in hypertensive patients with ApHCM. The global longitudinal strain was independently associated with ApHCM in hypertensive patients.

Ultraviolet-C AlGaN Resonant-Cavity Light-Emitting Diodes with Thermal Stability Pipe-AlGaN-Distributed Bragg Reflectors.

Ultraviolet-C AlGaN resonant-cavity light-emitting diodes with top and bottom pipe-AlGaN-distributed Bragg reflectors (DBRs) have been demonstrated. For the top/bottom DBR structures, 20 pairs of n+-AlGaN:Si/n-AlGaN:Si stack structures were transformed into the pipe-AlGaN:Si/n-AlGaN:Si DBRs through a doping-selective electrochemical wet etching process. The reflectivity of the pipe-AlGaN DBR structure was measured as 90% at 276.7 nm with a 20.9 nm flat stopband width. The anisotropic optical properties of the pipe-AlGaN DBR structure had been analyzed through the polarization-dependent reflectance spectra. For temperature-dependent reflectance spectra, the central wavelengths were slightly redshifted from 275 nm (100 K) to 281 nm (600 K) due to thermal expansion, refractive index increase, and partial strain release phenomena in the pipe-DBR structure. High photoluminescence emission intensity and line-width reducing phenomena were observed at 10 K in the UVC-LED with the resonant-cavity structure, which has potential for high-efficiency UV-C light source applications.

Prediction of survival time after terminal extubation: the balance between critical care unit utilization and hospice medicine in the COVID-19 pandemic era.

BACKGROUND: We established 1-h and 1-day survival models after terminal extubation to optimize ventilator use and achieve a balance between critical care for COVID-19 and hospice medicine. METHODS: Data were obtained from patients with end-of-life status at terminal extubation from 2015 to 2020. The associations between APACHE II scores and parameters with survival time were analyzed. Parameters with a p-value ≤ 0.2 in univariate analysis were included in multivariate models. Cox proportional hazards regression analysis was used for the multivariate analysis of survival time at 1 h and 1 day. RESULTS: Of the 140 enrolled patients, 76 (54.3%) died within 1 h and 35 (25%) survived beyond 24 h. No spontaneous breathing trial (SBT) within the past 24 h, minute ventilation (MV) ≥ 12 L/min, and APACHE II score ≥ 25 were associated with shorter survival in the 1 h regression model. Lower MV, SpO2 ≥ 96% and SBT were related to longer survival in the 1-day model. Hospice medications did not influence survival time. CONCLUSION: An APACHE II score of ≥ 25 at 1 h and SpO2 ≥ 96% at 1 day were strong predictors of disposition of patients to intensivists. These factors can help to objectively tailor pathways for post-extubation transition and rapidly allocate intensive care unit resources without sacrificing the quality of palliative care in the era of COVID-19. Trial registration They study was retrospectively registered. IRB No.: 202101929B0.

PARK6 PINK1 mutants are defective in maintaining mitochondrial membrane potential and inhibiting ROS formation of substantia nigra dopaminergic neurons.

Mutations in PTEN-induced kinase 1 (PINK1) gene cause recessive familial type 6 of Parkinson's disease (PARK6). PINK1 is believed to exert neuroprotective effect on SN dopaminergic cells by acting as a mitochondrial Ser/Thr protein kinase. Autosomal recessive inheritance indicates the involvement of loss of PINK1 function in PARK6 pathogenesis. In the present study, confocal imaging of cultured SN dopaminergic neurons prepared from PINK1 knockout mice was performed to investigate physiological importance of PINK1 in maintaining mitochondrial membrane potential (ΔΨ(m)) and mitochondrial morphology and test the hypothesis that PARK6 mutations cause the loss of PINK1 function. PINK1-deficient SN dopaminergic neurons exhibited a depolarized ΔΨ(m). In contrast to long thread-like mitochondria of wild-type neurons, fragmented mitochondria were observed from PINK1-null SN dopaminergic cells. Basal level of mitochondrial superoxide and oxidative stressor H(2)O(2)-induced ROS generation were significantly increased in PINK1-deficient dopaminergic neurons. Overexpression of wild-type PINK1 restored hyperpolarized ΔΨ(m) and thread-like mitochondrial morphology and inhibited ROS formation in PINK1-null dopaminergic cells. PARK6 mutant (G309D), (E417G) or (CΔ145) PINK1 failed to rescue mitochondrial dysfunction and inhibit oxidative stress in PINK1-deficient dopaminergic neurons. Mitochondrial toxin rotenone-induced cell death of dopaminergic neurons was augmented in PINK1-null SN neuronal culture. These results indicate that PINK1 is required for maintaining normal ΔΨ(m) and mitochondrial morphology of cultured SN dopaminergic neurons and exerts its neuroprotective effect by inhibiting ROS formation. Our study also provides the evidence that PARK6 mutant (G309D), (E417G) or (CΔ145) PINK1 is defective in regulating mitochondrial functions and attenuating ROS production of SN dopaminergic cells.

Anomalous structural phase transition properties in ReSe2 and Au-doped ReSe2.

The high pressure induced phase transition in rhenium diselenides (ReSe(2)) and gold-doped rhenium diselenides (Au-ReSe(2)) at ambient temperature have been investigated using angular-dispersive x-ray diffraction (ADXRD) under high pressure up to around 10.50 and 9.98 GPa, respectively. In situ ADXRD measurements found that the phase transition pressures of ReSe(2) and Au-ReSe(2) began at 9.98 and 8.52 GPa, respectively. Compressibilities analysis shows the relationship of along c-axis > along a-axis > along b-axis. The linear compressibility of the pressure dependence of α, ß, and γ of ReSe(2) shows that a phase transition can be related to a counterclockwise rotational trend of the selenium atoms around the chain of Re(4) atoms during the decrease of the c-axis distance by a combination of stresses due to the bending effect of α and stretching effect of ß. The cause of the reduction of the phase transition pressure of Au-ReSe(2) is attributed mainly to a structural distortion as evidenced by the observation of a weak clockwise rotational trend of Se atoms around the chain of Re(4) atoms in the pressure range 3.99-4.99 GPa which subsequently reversed to counterclockwise rotation under higher pressure.

Similar major cardiovascular outcomes between pure statin and ezetimibe-statin in comparable intensity for type 2 diabetes with extremely atherosclerotic risks.

Atorvastatin 40 mg (ATOR 40) and ezetimibe 10 mg/simvastatin 20 mg (EZ-SIM 20) have similar reductions of low-density lipoprotein cholesterol (LDL-C) but cardiovascular (CV) outcomes between these two therapies are unclear. Our real-world cohort study is to test the hypothesis of pleiotropic effects of purely higher dose statin on CV outcomes beyond similar reductions of LDL-C, especially for extremely CV risk patients. Between January 1, 2007 and December 31, 2013, a total of 3,372 patients with type 2 diabetes mellitus (T2DM) admitted due to acute coronary syndrome (ACS) or acute ischemic stroke (AIS) were selected as the study cohort from the Taiwan National Health Insurance Research Database. Clinical outcomes were evaluated by ATOR 40 group (n = 1686) matched with EZ-SIM 20 group (n = 1686). Primary composite outcome includes CV death, non-fatal myocardial infarction, and non-fatal stroke. Secondary composite outcome includes hospitalization for unstable angina (HUA), percutaneous coronary intervention (PCI), and coronary artery bypass grafting (CABG). With a mean follow-up of 2.4 years, no significant difference of primary composite outcome was observed between ATOR 40 and EZ-SIM 20 groups (subdistribution hazard ratio [SHR], 1.09; 95% confidence interval [CI], 0.95-1.25). Nevertheless, ATOR 40 group had lower risks of HUA (SHR, 0.50; 95% CI, 0.35-0.72), PCI (SHR, 0.82; 95% CI, 0.69-0.97) and CABG (SHR, 0.62; 95% CI, 0.40-0.97) than EZ-SIM 20 group. For T2DM patients after ACS or AIS, ATOR 40 and EZ-SIM 20 had similar major CV outcomes, which still supported the main driver for CV risk reductions is LDL-C lowering.

Compliance and schizophrenia: the predictive potential of insight into illness, symptoms, and side effects.

BACKGROUND: Personal beliefs about medication compliance have been reliably associated with emotional and behavioral response to mental health problems and health outcomes. This notion has been extensively explored in relation to mental illness. In the current study, a questionnaire designed to assess beliefs about medication compliance (the medication adherence rating scale [MARS]) was translated into Taiwanese to explore beliefs about compliance in schizophrenic patients. METHODS: In this cross-sectional study, 104 patients who met Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, criteria for schizophrenic disorders were recruited and independently interviewed. We first determined the psychometric properties of the translated MARS, including internal consistency, test-retest reliability, and construct validity. In addition, we investigated the relationships between medication compliance and clinical variables through correlation and regression analyses. RESULTS: We found that the translated MARS was a simple and reliable self-reported compliance scale. Furthermore, in this exploratory study, we found that patients with better medication compliance had better insight into mental illness, less severe psychopathologic condition, and less negative subjective response to side effects of antipsychotics. CONCLUSIONS: Additional research focusing on these patient outcomes will be of great interest and value in elucidating the role of medication compliance in management of schizophrenic patients.

Alpha adrenergic modulation on effects of norepinephrine transporter inhibitor reboxetine in five-choice serial reaction time task.

The study examined the effects of a norepinephrine transporter (NET) inhibitor reboxetine (RBX) on an attentional performance test. Adult SD rats trained with five-choice serial reaction time task (5-CSRTT) were administered with RBX (0, 3.0 and 10 mg/kg) in the testing day. Alpha-1 adrenergic receptor antagonist PRA and alpha-2 adrenergic receptor antagonist RX821002 were used to clarify the RBX effect. Results revealed that rat received RBX at 10 mg/kg had an increase in the percentage of the correct response and decreases in the numbers of premature response. Alpha-1 adrenergic receptor antagonist Prazosin (PRA) at 0.1 mg/kg reversed the RBX augmented correct responding rate. However, alpha-2 adrenergic receptor antagonist RX821002 at 0.05 and 0.1 mg/kg dose dependently reversed the RBX reduced impulsive responding. Our results suggested that RBX as a norepinephrine transporter inhibitor can be beneficial in both attentional accuracy and response control and alpha-1 and alpha-2 adrenergic receptors might be involved differently.

An efficient and stable photoelectrochemical system with 9% solar-to-hydrogen conversion efficiency via InGaP/GaAs double junction.

Despite III-V semiconductors demonstrating extraordinary solar-to-hydrogen (STH) conversion efficiencies, high cost and poor stability greatly impede their practical implementation in photoelectrochemical (PEC) water splitting applications. Here, we present a simple and efficient strategy for III-V-based photoelectrodes that functionally and spatially decouples the light harvesting component of the device from the electrolysis part that eliminates parasitic light absorption, reduces the cost, and enhances the stability without any compromise in efficiency. The monolithically integrated PEC cell was fabricated by an epitaxial lift-off and transfer of inversely grown InGaP/GaAs to a robust Ni-substrate and the resultant photoanode exhibits an STH efficiency of ~9% with stability ~150 h. Moreover, with the ability to access both sides of the device, we constructed a fully-integrated, unassisted-wireless "artificial leaf" system with an STH efficiency of ~6%. The excellent efficiency and stability achieved herein are attributed to the light harvesting/catalysis decoupling scheme, which concurrently improves the optical, electrical, and electrocatalytic characteristics.

Performance comparison of III-V//Si and III-V//InGaAs multi-junction solar cells fabricated by the combination of mechanical stacking and wire bonding.

The integration of III-V and Si multi-junction solar cells as photovoltaic devices has been studied in order to achieve high photovoltaic conversion efficiency. However, large differences in the coefficients of thermal expansion and the lattice parameters of GaAs, Si, and InGaAs have made it difficult to obtain high-efficiency solar cells grown as epilayers on Si and InP substrates. In this paper, two types of devices, including GaInP/GaAs stacked on Si (GaInP/GaAs//Si) and GaInP/GaAs stacked on InGaAs (GaInP/GaAs//InGaAs), are fabricated via mechanical stacking and wire bonding technologies. Mechanically stacked GaInP/GaAs//Si and GaInP/GaAs//InGaAs triple-junction solar cells are prepared via glue bonding. Current-voltage measurements of the two samples are made at room temperature. The short-circuit current densities of the GaInP/GaAs//Si and GaInP/GaAs//InGaAs solar cells are 13.37 and 13.66 mA/cm2, while the open-circuit voltages of these two samples are measured to be 2.71 and 2.52 V, respectively. After bonding the GaInP/GaAs dual-junction with the Si and InGaAs solar cells, the conversion efficiency is relatively improved by 32.6% and 30.9%, respectively, compared to the efficiency of the GaInP/GaAs dual-junction solar cell alone. This study demonstrates the high potential of combining mechanical stacked with wire bonding and ITO films to achieve high conversion efficiency in solar cells with three or more junctions.

Two-dimensional myocardial deformation in coronary vasospasm-related Takotsubo cardiomyopathy: A case report of a serial echocardiographic study.

RATIONALE: Although transient reduction in the left ventricular ejection fraction is characteristic of Takotsubo cardiomyopathy, little is known about the time-course changes of myocardial deformation in coronary vasospasm-related Takotsubo cardiomyopathy. PATIENT CONCERNS: We retrospectively analyzed the time-course changes in left ventricle, right ventricle, and left atrium strain values in a patient with coronary vasospasm-related Takotsubo cardiomyopathy. We found that not only left ventricular strain but also left atrial strain was abnormal during acute Takotsubo cardiomyopathy due to coronary vasospasm. Right ventricular free wall strain was normal. DIAGNOSES: Coronary vasospasm-related Takotsubo cardiomyopathy. INTERVENTIONS: A serial echocardiographic study. OUTCOMES: The left ventricular strain was still subnormal despite a normalized left ventricular ejection fraction 2 months later. The left atrial strain was normal when the left ventricular ejection fraction normalized. LESSONS: From this limited experience, it is suggested that echocardiographic myocardial deformation analysis can provide more information than the standard ejection fraction in evaluating myocardial contractile function.