Beyond apical ballooning: computational modelling reveals morphological features of Takotsubo cardiomyopathy

Giulia Pontecorboli,Giovanni Biglino,Elena Giulia Milano,Froso Sophocleous,Benedetta Biffi,Amardeep Ghosh Dastidar,Silvia Schievano,Carlo Di Mario,Chiara Bucciarelli-Ducci

doi:10.1080/10255842.2019.1632836

Abstract

Takotsubo cardiomyopathy (TCM) is characterized by transient myocardial dysfunction, typically at the left ventricular (LV) apex. Its pathophysiology and recovery mechanisms remain unknown. We investigated LV morphology and deformation in n = 28 TCM patients. Patients with MRI within 5 days from admission (“early TCM”) showed reduced LVEF and higher ventricular volumes, but no differences in ECG, global strains or myocardial oedema. Statistical shape modelling described LV size (Mode 1), apical sphericity (Mode 2) and height (Mode 3). Significant differences in Mode 1 suggest that “early TCM” LV remodeling is mainly influenced by a change in ventricular size rather than apical sphericity.

Highlights

Takotsubo cardiomyopathy (TCM) is a defined type of cardiomyopathy, frequently precipitated by a stressful event and characterized by transient regional myocardial dysfunction
No significant differences between the two cohorts were found in ECG parameters, nor in the CMRderived amount of edema (% left ventricular (LV) mass and grams), nor in 2 D-FT CMR global strains
Our study investigated ventricular morphology and deformation by means of 2 D-Feature-tracking cardiac MRI (FT-CMR) and 3 D-Statistical Shape Modelling analysis (SSM) in patients with TCM in acute and sub-acute phases

Summary

Introduction

Takotsubo cardiomyopathy (TCM) is a defined type of cardiomyopathy, frequently precipitated by a stressful event and characterized by transient regional myocardial dysfunction. The latter is typically localized at the left ventricular (LV) apex and referred to as “apical ballooning” (Prasad et al 2008). Previous studies have highlighted that the rapid improvement in LV ejection fraction is not accompanied by a recovery of LV deformation, which continues to impaired at 4-month follow-up and associated with altered cardiac energetic status and persistence of symptoms (Schwarz et al 2017; Dawson et al 2015). Our study aimed to investigate ventricular morphology, function and deformation in TCM patients in the early stage of the disease using 2 D-Feature-tracking cardiac MRI (FT-CMR) and 3 D-Statistical Shape Modelling analysis (SSM)

Methods

Results

Conclusion