777 Tissue Characterization in Takotsubo Syndrome

Abstract

Aims Takotsubo Syndrome (TTS), also known as stress cardiomyopathy, is an important form of acute reversible myocardial damage characterized by a transient systolic dysfunction of the left ventricle, which generally occurs following intense emotional or physical stress. The availability of new imaging techniques broadened knowledge about TTS and allowed for more accurate risk stratification and their use as a potential guide to clinical management. The aims of our study was that of evaluating changes in myocardial tissue characterization on cardiac magnetic resonance imaging in patients diagnosed with TTS admitted to our center. Methods and Results From December 2018 to December 2021, 52 patients diagnosed with TTS according to the 2018 InterTAK diagnostic criteria were admitted to our ICU; only 27 patients who underwent cardiac magnetic resonance imaging were included in our study. Cardiac magnetic resonance was performed after an average of 7 days from admission to the ward, therefore not in all patients the regional wall motion abnormalities of the left ventricle found on the first echocardiogram performed were then still evident. Despite this, at the evaluation of the T2-STIR sequences, the presence of myocardial edema in the segments with previous regional dissynergies was highlighted in all patients included in the study, indicating a greater sensitivity of tissue characterization techniques. Furthermore, the analysis of T2 mapping, for the quantification of edema, also showed a significant lengthening of the average values ​​of the global T2 mapping, compared to the reference values ​​at our center [65.9 +/- 7.7 msec, vn T2 mapping = 53 ± 3 msec; mean baseline T2 mapping value: 60.4 +/- 5.5 msec, mean T2 mapping value: 65 +/- 7.1 msec, apical T2 mapping: 71 +/- 7.7 msec], with evidence of a clear base-apex gradient on 19/23 patients (82.6%) compatible with the greater involvement of the mid-apical segments typical of the classic form of "apical ballooning" TTS. Finally, the evaluation of the systolic strain also showed a significant reduction in the values ​​both in the radial component and in the circumferential and longitudinal components, especially in the mid-apical segments, even in the absence of significant regional wall motion abnormalities or with preserved left ventricular EF [mean values global radial strain (GRS) of 28.6 +/- 9.5; global circumferential strain (GCS) of 15.4 +/- 7.9; global longitudinal strain (GLS) of 12.6 +/- 3.2]. Conclusions Our study confirms that tissue characterization and functional evaluation techniques using myocardial strain with cardiac magnetic resonance appear to be more accurate, compared to the evaluation of regional wall motion abnormalities and left ventricular EF alone, in identifying pathophysiological changes and in diagnostic framework of TTS patients.