Abstract
BackgroundThe pathophysiological significance of dyssynchrony and rotation in Takotsubo syndrome (TTS) is unknown. We aimed to define the influence of cardiovascular magnetic resonance feature tracking (CMR-FT) dyssynchrony and rotational mechanics in acute and during clinical course of TTS. MethodsThis multicenter study included 152 TTS patients undergoing CMR (mean 3 days after symptom onset). Apical, midventricular and basal short axis views were analysed in a core-laboratory. Systolic torsion, diastolic recoil and dyssynchrony expressed as circumferential and radial uniformity ratio estimates (CURE and RURE: 0 to 1; 1 = perfect synchrony) were compared to a matched control group (n = 21). Follow-up CMR (n = 20 patients; mean 62 days, SD 7.2) and general follow-up (n = 136; mean 3.3 years, SD 2.4) were performed. ResultsCURE was initially reduced compared to controls (p = 0.001) and recovered at follow-up (p < 0.001) as opposed to RURE (p = 0.116 and p = 0.179). CURE and RURE discriminated between ballooning patterns (p = 0.001 and p = 0.045). Recoil was generally impaired during the acute phase (p = 0.015), torsion only in highly dyssynchronous patients (p = 0.024). Diabetes (p = 0.007), physical triggers (p = 0.013) and malignancies (p = 0.001) predicted mortality. The latter showed a distinct association with impaired torsion (p = 0.042) and dyssynchrony (p = 0.047). Physical triggers and malignancies were related to biventricular impairment (p = 0.004 and p = 0.026), showing higher dyssynchrony (p < 0.01), greater reduction of left ventricular function (p < 0.001) and a strong trend towards increased mortality (p = 0.074). ConclusionTransient circumferential dyssynchrony and impaired rotational mechanics are distinct features of TTS with different severities according to the pattern of ballooning. Patients with malignancies and precipitating physical triggers frequently show biventricular affection, greater dyssynchrony and high mortality risk.
Highlights
Takotsubo syndrome (TTS), referred to as Takotsubo cardiomyopathy, left ventricular apical ballooning syndrome and stress-induced cardiomyopathy [1], is an increasingly recognized heart condition which often occurs related to a stressful trigger with an acute onset and symptoms comparable to those of an acute coronary syndrome [2].S.J
The ballooning patterns were distributed as follows: 108 patients presented with apical ballooning (71.1%), 40 (26.3%) with midventricular and 2 (1.3%) presented with basal ballooning (Table 2)
The was no presence of late gadolinium enhancement (LGE) in any patient as defined by N5 standard deviation (SD) compared to remote myocardium
Summary
Takotsubo syndrome (TTS), referred to as Takotsubo cardiomyopathy, left ventricular apical ballooning syndrome and stress-induced cardiomyopathy [1], is an increasingly recognized heart condition which often occurs related to a stressful trigger with an acute onset and symptoms comparable to those of an acute coronary syndrome [2].S.J. We aimed to define the influence of cardiovascular magnetic resonance feature tracking (CMR-FT) dyssynchrony and rotational mechanics in acute and during clinical course of TTS. Diabetes (p = 0.007), physical triggers (p = 0.013) and malignancies (p = 0.001) predicted mortality The latter showed a distinct association with impaired torsion (p = 0.042) and dyssynchrony (p = 0.047). Physical triggers and malignancies were related to biventricular impairment (p = 0.004 and p = 0.026), showing higher dyssynchrony (p b 0.01), greater reduction of left ventricular function (p b 0.001) and a strong trend towards increased mortality (p = 0.074). Conclusion: Transient circumferential dyssynchrony and impaired rotational mechanics are distinct features of TTS with different severities according to the pattern of ballooning. Patients with malignancies and precipitating physical triggers frequently show biventricular affection, greater dyssynchrony and high mortality risk
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