Abstract
BackgroundA substantial number of patients with Takotsubo syndrome (TTS) exhibit right ventricular (RV) dysfunction which has been associated with adverse outcome. The aim of this study was to assess the clinical and prognostic value of RV myocardial strain in TTS using cardiovascular magnetic resonance myocardial feature tracking (CMR-FT).MethodsCMR-FT was performed in a core laboratory to determine RV longitudinal strain in 134 TTS patients undergoing CMR in median 2 days after admission to 2 experienced centers. For comparison, RV involvement was evaluated by sole visual assessment concerning RV contraction abnormalities. Both approaches were analyzed regarding their long-term prognostic value.ResultsThe peak global RV longitudinal strain was in median -19%. Segmental analyses located contraction abnormalities primarily in the apical parts of the right ventricle. Sole visual assessment identified 38 patients (28%) with RV involvement. These patients showed a numerically higher long-term mortality without reaching statistical significance (17.1% versus 10.5%; hazard ratio 1.38 [95% confidence interval 0.49–3.88]; p = 0.31). The optimal RV strain cutoff value for risk prediction was -17.24%. Stratification according to this threshold categorized 41% of TTS patients (n = 55) in the high-risk group which demonstrated a significantly increased long-term mortality compared to patients with preserved global RV strain (20.0% versus 7.0%; hazard ratio 2.98 [95% confidence interval 1.02–8.73]; p = 0.03).ConclusionsThe assessment of RV myocardial strain using CMR-FT enables an accurate evaluation of RV involvement in TTS and represents a promising approach for optimized risk stratification.
Highlights
Takotsubo syndrome (TTS) is a form of acute heart failure due to circumscribed left ventricular (LV) contraction abnormalities constituting the morphological picture of apical, midventricular, or basal ballooning. [1–3] In addition, right ventricular (RV) involvement has been reported in a substantial number of TTS patients. [3–10] cardiac function recovers completely within several days to weeks, considerable mortality rates and a variety of potentially life-threatening complications have been reported in TTS populations. [11–14] In a large TTS registry, the death rate was estimated to be 5.6% per patient-year. [12] recent research efforts focused mainly on prognostic factors in TTS and identified visual assessment of RV ballooning, among others, as a potential tool for optimized risk stratification
The assessment of RV myocardial strain using Cardiovascular magnetic resonance (CMR)-FT enables an accurate evaluation of RV involvement in TTS and represents a promising approach for optimized risk stratification
The results suggest that this novel technique allows for a reliable and optimized detection of RV involvement in patients with TTS and a more accurate risk stratification compared to sole visual assessment
Summary
Takotsubo syndrome (TTS) is a form of acute heart failure due to circumscribed left ventricular (LV) contraction abnormalities constituting the morphological picture of apical, midventricular, or basal ballooning. [1–3] In addition, right ventricular (RV) involvement has been reported in a substantial number of TTS patients. [3–10] cardiac function recovers completely within several days to weeks, considerable mortality rates and a variety of potentially life-threatening complications have been reported in TTS populations. [11–14] In a large TTS registry, the death rate was estimated to be 5.6% per patient-year. [12] recent research efforts focused mainly on prognostic factors in TTS and identified visual assessment of RV ballooning, among others, as a potential tool for optimized risk stratification. [1–3] In addition, right ventricular (RV) involvement has been reported in a substantial number of TTS patients. Assessment of myocardial strain has shown to overcome some of these shortcomings in TTS patients [15] but still echocardiography is limited by the dependency on acoustic windows and operator experience. Aim of the present study was to determine CMR-FT derived RV myocardial strain in a large cohort of patients with TTS and to assess the clinical and prognostic value of this novel approach. A substantial number of patients with Takotsubo syndrome (TTS) exhibit right ventricular (RV) dysfunction which has been associated with adverse outcome. The aim of this study was to assess the clinical and prognostic value of RV myocardial strain in TTS using cardiovascular magnetic resonance myocardial feature tracking (CMR-FT)
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