Prognostic Value of Different CMR-Based Techniques to Assess Left Ventricular Myocardial Strain in Takotsubo Syndrome

Abstract

Cardiac magnetic resonance (CMR)-derived left ventricular (LV) global longitudinal strain (GLS) provides incremental prognostic information on various cardiovascular diseases but has not yet been investigated comprehensively in patients with Takotsubo syndrome (TS). This study evaluated the prognostic value of feature tracking (FT) GLS, tissue tracking (TT) GLS, and fast manual long axis strain (LAS) in 147 patients with TS, who underwent CMR at a median of 2 days after admission. Long-term mortality was assessed 3 years after the acute event. In contrast to LV ejection fraction and tissue characteristics, impaired FT-GLS, TT-GLS and fast manual LAS were associated with adverse outcome. The best cutoff points for the prediction of long-term mortality were similar with all three approaches: FT-GLS −11.28%, TT-GLS −11.45%, and fast manual LAS −10.86%. Long-term mortality rates were significantly higher in patients with FT-GLS > −11.28% (25.0% versus 9.8%; p = 0.029), TT-GLS > −11.45% (20.0% versus 5.4%; p = 0.016), and LAS > −10.86% (23.3% versus 6.6%; p = 0.014). However, in multivariable analysis, diabetes mellitus (p = 0.001), atrial fibrillation (p = 0.001), malignancy (p = 0.006), and physical triggers (p = 0.006) outperformed measures of myocardial strain and emerged as the strongest, independent predictors of long-term mortality in TS. In conclusion, CMR-based longitudinal strain provides valuable prognostic information in patients with TS, regardless of the utilized technique of assessment. Long-term mortality, however, is mainly determined by comorbidities.

Prognostic factors of Takotsubo cardiomyopathy: a systematic review

“…Many studies show that physical triggers are associated with poor short‐term 8 , 70 , 80 , 84 , 85 and long‐term 41 , 42 , 49 , 55 , 62 , 75 , 86 , 87 outcomes in TCM ( Table 4 ). One study divided TCM patients into three classes according to their triggers: emotional triggers as Class I (485 patients), physical triggers as Class II (532 patients with physical activities, medical conditions, or procedures as Class IIa, 98 patients with neurologic disorders as Class IIb), and no identifiable trigger as Class III (498 patients).…”

“…Malignant disease remains a predictor of poorer long‐term outcome in TCM patients. 26 , 41 , 42 , 43 , 44 , 45 , 51 , 54 , 56 , 60 , 62 , 71 , 75 , 77 , 86 , 107 , 108 , 109 The latest meta‐analysis of the association between malignant disease and TCM patients included 10 studies and 126 322 patients and suggested that malignant disease was associated with greater mortality in TCM patients (RR 2.23, 95% CI 1.64–3.03,), including both inpatient mortality (RR 2.26, 95% CI 1.34–3.82) and long‐term mortality (RR 2.04, 95% CI 1.63–2.55). 107 In one study of 1604 TCM patients, those with malignant disease had a higher 10 year mortality rate (HR 1.84, 95% CI 1.29–2.61).…”

Myocardial Deformation Parameters Assessed By CMR Feature Tracking In Chronic Heart Failure: The Influence of An Optimal Medical Therapy On Myocardial Remodeling

“…Positive left ventricular remodeling in strain parameters has been shown to be a predictor of myocardial recovery in many entities [19,20]. Interestingly, an improvement in RV GLS both in the overall cohort and in the HFrEF and HFpEF cohorts was observed on follow-up CMR examination.…”

Quantification of Myocardial Deformation Applying CMR-Feature-Tracking—All About the Left Ventricle?

“…Other cardiomyopathies, in which CMR imaging can significantly contribute to correct diagnosis finding by precisely assessing typical cardiac pathomorphology and FT-derived quantification over and above LV evaluation, were shown to be feasible and provide additional important prognostic information comprising hypertrophic cardiomyopathy (HCM) [64], Takotsubo cardiomyopathy (TTC) [65,66], restricted cardiomyopathies like amyloidosis and sarcoidosis [67,68] or arrhythmogenic right ventricular cardiomyopathy (ARVC) [69].…”